Validation of the AAST EGS acute cholecystitis grade and comparison with the Tokyo guidelines

Purpose. To identify significant independent preoperative factors influencing postoperative hospital stay (PHS) and medical costs (MC) in 171 patients who underwent cholecystectomy for benign gallbladder diseases and had definite, suspected, or unmatched acute cholecystitis (AC) diagnosis according to the Tokyo Guidelines 2013 (TG13).Methods.The 171 patients were classified according to the combination of diagnostic criteria including local signs of inflammation (A), systemic signs of inflammation (B), and imaging findings (C): A+ B+ C (definite diagnosis,n=84), A+ B (suspected diagnosis,n=25), (A or B) + C (n=10), A (n=41), and B (n=11).Results. The A+ B + C and (A or B) + C groups had equivalent PHS and MC, suggesting that imaging findings were essential for AC diagnosis. PHS and MC were significantly increased in the order of severity grades based on TG13. Performance status (PS), white blood cell count, and severity grade were identified as preoperative factors influencing PHS by multivariate analysis, and significant independent preoperative factors influencing MC were age, PS, preoperative biliary drainage, hospital stay before surgery, albumin, and severity grade.Conclusion. PS and severity grade significantly influenced prolonged PHS and increased MC.

Download Full-text

Modified Socratic Method (planned and executed by Takada) for Medical Education: Grade II Acute Cholecystitis of Tokyo Guidelines 2018 as an Example Case

Journal of Hepato-Biliary-Pancreatic Sciences ◽

10.1002/jhbp.1076 ◽

2021 ◽

Author(s):

Tadahiro Takada ◽

Shuji Isaji ◽

Masahiro Yoshida ◽

Akihiko Horiguchi ◽

Hisami Ando ◽

...

Keyword(s):

Medical Education ◽

Acute Cholecystitis ◽

Socratic Method ◽

Tokyo Guidelines ◽

Grade Ii

Download Full-text

Does the Tokyo guidelines predict the extent of gallbladder inflammation in patients with acute cholecystitis? A single center retrospective analysis

BMC Gastroenterology ◽

10.1186/s12876-015-0365-4 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 27

Author(s):

Peter C. Ambe ◽

Hildegard Christ ◽

Dirk Wassenberg

Keyword(s):

Acute Cholecystitis ◽

Retrospective Analysis ◽

Single Center ◽

Tokyo Guidelines ◽

Gallbladder Inflammation

Download Full-text

Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines

Journal of Hepato-Biliary-Pancreatic Surgery ◽

10.1007/s00534-006-1161-x ◽

2007 ◽

Vol 14 (1) ◽

pp. 91-97 ◽

Cited By ~ 119

Author(s):

Yuichi Yamashita ◽

Tadahiro Takada ◽

Yoshifumi Kawarada ◽

Yuji Nimura ◽

Masahiko Hirota ◽

...

Keyword(s):

Surgical Treatment ◽

Acute Cholecystitis ◽

Tokyo Guidelines

Download Full-text

The Accuracy of Point-of-Care Ultrasound in the Diagnosis of Acute Cholecystitis

The American Surgeon ◽

10.1177/0003134821989057 ◽

2021 ◽

pp. 000313482198905

Author(s):

Chase J. Wehrle ◽

Asif Talukder ◽

Lillie Tien ◽

Soham Parikh ◽

Aditya Devarakonda ◽

...

Keyword(s):

Acute Cholecystitis ◽

Point Of Care ◽

Tertiary Care ◽

Laboratory Data ◽

Final Diagnosis ◽

Gallbladder Wall ◽

Clinical Findings ◽

Point Of Care Ultrasound ◽

Tokyo Guidelines ◽

Pathology Reports

Purpose Acute cholecystitis (AC) affects 50-200 000 patients per year. Early surgery is the treatment of choice for AC. Therefore, timely diagnosis is important to begin proper management. Recently, emergency departments have adopted point-of-care ultrasound (POCUS) for the initial evaluation of AC. The accuracy of POCUS for AC has not been well studied. Methods Patients receiving POCUS for evaluation of AC in the emergency department at our tertiary care institution for 2 years were considered. Patients with previous biliary diagnoses were excluded. Patients were deemed to have AC from a recorded POCUS result or 2/3 of the following POCUS findings: pericholecystic fluid, gallbladder wall hyperemia, and sonographic Murphy’s sign. Formal ultrasound and final diagnosis from surgical and pathology reports were used as gold standards for comparison. Results In total, 147 patients met inclusion criteria. POCUS had a sensitivity and specificity of .4 (95% CI: .1216-.7376) and .99 (.9483-.9982), respectively, when compared to a final diagnosis and .33 (.0749-.7007) and .94 (.8134-.9932) when compared to formal US. The modified Tokyo guidelines for suspicion of AC had a sensitivity of .2 (.0252-.5561) and specificity of .88 (.8173-.931) compared to the final diagnosis. Conclusion Point-of-care ultrasound was not a better screening test than the modified Tokyo guidelines. We recommend a simplified screening approach for AC using clinical findings and laboratory data, followed by confirmatory formal imaging. This strategy could prevent unnecessary delays in surgical management and use of physician resources.

Download Full-text

Plasma Procalcitonin Is Useful for Predicting the Severity of Acute Cholecystitis

Emergency Medicine International ◽

10.1155/2020/8329310 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Saben Sakalar ◽

Engin Ozakın ◽

Arif Alper Cevik ◽

Nurdan Acar ◽

Serkan Dogan ◽

...

Keyword(s):

Emergency Department ◽

Early Diagnosis ◽

Acute Cholecystitis ◽

Delayed Diagnosis ◽

Morbidity And Mortality ◽

Radiological Diagnosis ◽

Common Complication ◽

Tokyo Guidelines ◽

Grade 3

Background. Acute cholecystitis is a common complication of cholelithiasis. Delayed diagnosis may constitute morbidity and mortality; therefore, early diagnosis and determining the severity of acute cholecystitis are crucial. Objectives. This study aimed to determine the validity of blood procalcitonin (PCT) levels in assessing the severity of acute cholecystitis. Methods. The Emergency Department (ED) patients diagnosed as acute cholecystitis were included in the study. Patients were allocated into three severity grades according to the Tokyo Guidelines 2013. PCT level was measured after the clinical and radiological diagnosis of acute cholecystitis in the ED. Results. Ninety-five patients diagnosed with acute cholecystitis, among them 48 of were male. Forty patients (42.1%) were allocated to grade 1, 19 (20%) to grade 2, and 36 (37.9%) to grade 3. The median values of PCT were 0.104 ng/ml, 0.353 ng/ml, and 1.466 ng/ml for grade 1, 2, and 3 patients, respectively (p<0.001). Conclusion. Blood procalcitonin levels can be used to determine the severity of acute cholecystitis effectively.

Download Full-text