Abstract
Purpose
Three years have passed since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis, and we believe that the time has come to assess their validity.
Methods
In this study, we validated the diagnostic accuracy of these criteria in 74 patients with an initial diagnosis of acute cholangitis and 81 patients with an initial diagnosis of acute cholecystitis. We also statistically compared the accuracy of the diagnosis made based on the Tokyo Guidelines with that based on the presence of Charcot’s triad for acute cholangitis and Murphy’s sign for acute cholecystitis with use of the sign test to assess differences.
Results
The results revealed that the diagnostic sensitivity and specificity of the Tokyo Guidelines for suspected or definitive acute cholangitis were 72.1 and 38.5%, respectively, and the corresponding values for definitive cholangitis alone were 63.9 and 69.2%, respectively. For definitive acute cholecystitis, the diagnostic sensitivity and specificity of the Tokyo Guidelines were 84.9 and 50.0%, respectively. The accuracy of diagnosis based on the Tokyo Guidelines was significantly higher than that based on the presence of Charcot’s triad (acute cholangitis, p < 0.001 by the sign test) or Murphy’s sign (acute cholecystitis, p < 0.001 by the sign test).
Conclusions
It was therefore concluded that the Tokyo Guidelines should be used more widely for the diagnosis of acute cholangitis and cholecystitis in the twenty-first century. Hereafter, various efforts should be made to improve the sensitivity and specificity of the diagnostic criterion of the Tokyo Guidelines.
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Acknowledgments
I would like to extend my deepest gratitude to the physicians of the Department of Gastrointestinal Medicine, Nagoya Daini Red Cross Hospital. This study was partly conducted by the 2009 Sciences Research Grants program of the Japanese Ministry of Health, Labour, and Welfare.
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Yokoe, M., Takada, T., Mayumi, T. et al. Accuracy of the Tokyo Guidelines for the diagnosis of acute cholangitis and cholecystitis taking into consideration the clinical practice pattern in Japan. J Hepatobiliary Pancreat Sci 18, 250–257 (2011). https://doi.org/10.1007/s00534-010-0338-5
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DOI: https://doi.org/10.1007/s00534-010-0338-5