ヒグチ　リヨウタ   Higuchi Riyouta   樋口　亮太    所属   医学部 医学科（附属八千代医療センター）    職種   講師
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos).
掲載誌名	正式名：Journal of hepato-biliary-pancreatic sciences 略　 称：J Hepatobiliary Pancreat Sci ISSNコード：(1868-6982)1868-6974(Linking)
掲載区分	国内
巻・号・頁	25(1),pp.17-30
著者・共著者	KIRIYAMA Seiki,KOZAKA Kazuto,TAKADA Tadahiro,Strasberg Steven M,Pitt Henry A,GABATA Toshifumi,HARTA Jiro,Liau Kui-Hin,MIURA Fumihiko,HORIGUCHI Akihiko,Liu Keng-Hao,Su Cheng-Hsi,WADA Keita,Jagannath Palepu,ITOI Takao,Gouma Dirk J,MORI Yasuhisa,MUKAI Shuntaro,Giménez Mariano Eduardo,Huang Wayne Shih-Wei,Kim Myung-Hwan,OKAMOTO Kohji,Belli Giulio,Dervenis Christos,Chan Angus C W,Lau Wan Yee,ENDO Itaru,GOMI Harumi,YOSHIDA Masahiro,MAYUMI Toshihiko,Baron Todd H,de Santibañes Eduardo,Teoh Anthony Yuen Bun,Hwang Tsann-Long,Ker Chen-Guo,Chen Miin-Fu,Han Ho-Seong,Yoon Yoo-Seok,Choi In-Seok,Yoon Dong-Sup,HIGUCHI Ryota,KITANO Seigo,INOMATA Masafumi,Deziel Daniel J,Jonas Eduard,HIRATA Koichi,SUMIYAMA Yoshinobu,IMUI Kazuo,YAMAMOTO Masakazu
発行年月	2018/01
概要	Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
DOI	10.1002/jhbp.512
PMID	29032610