Tokyo Guidelines
Recently Published Documents


TOTAL DOCUMENTS

119
(FIVE YEARS 78)

H-INDEX

27
(FIVE YEARS 13)

2021 ◽  
Author(s):  
Yao Peng ◽  
Zhihui Chang ◽  
Zhaoyu Liu

Abstract Background: Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy.Methods: Data from patients with acute cholecystitis who had undergone PC from January 1, 2017, to December 31, 2019, in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy.Results: In total, 205 participants were identified, and 67 (32.7%) patients did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that Tokyo guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27–11.49; p=0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59–12.50; p=0.005), albumin level <28 g/L (OR: 4.15; 95% CI: 1.09–15.81; p=0.037), and history of malignancy (OR: 4.65; 95% CI: 1.62–13.37; p=0.004) were independent risk factors for a patient’s failure to undergo interval cholecystectomy. Among them, history of malignancy showed the highest predictor point on the nomogram for predicting non-interval cholecystectomy.Conclusions: TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and history of malignancy are the factors influencing failure to undergo cholecystectomy after PC in patients with acute cholecystitis.


2021 ◽  
Vol 161 (1) ◽  
pp. e22
Author(s):  
Ahmad Alkaddour ◽  
Amit Hudgi ◽  
Anabel Liyen Cartelle ◽  
Amr Ahmed ◽  
Carlos Palacio ◽  
...  

2021 ◽  
pp. 1-9
Author(s):  
Ramkumar Mohan ◽  
Stefanie Wei Lynn Goh ◽  
Guan Wei Tan ◽  
Yen Pin Tan ◽  
Sameer P. Junnarkar ◽  
...  

<b><i>Background:</i></b> Acute cholangitis (AC) is a common emergency with a significant mortality risk. The Tokyo Guidelines (TG) provide recommendations for diagnosis, severity stratification, and management of AC. However, validation of the TG remains poor. This study aims to validate TG07, TG13, and TG18 criteria and identify predictors of in-hospital mortality in patients with AC. <b><i>Methods:</i></b> This is a retrospective audit of patients with a discharge diagnosis of AC in the year 2016. Demographic, clinical, investigation, management and mortality data were documented. We performed a multinomial logistic regression analysis with stepwise variable selection to identify severity predictors for in-hospital mortality. <b><i>Results:</i></b> Two hundred sixty-two patients with a median age of 75.9 years (IQR 64.8–82.8) years were included for analysis. TG13/TG18 diagnostic criteria were more sensitive than TG07 diagnostic criteria (85.1 vs. 75.2%; <i>p</i> &#x3c; 0.006). The majority of the patients (<i>n</i> = 178; 67.9%) presented with abdominal pain, pyrexia (<i>n</i> = 156; 59.5%), and vomiting (<i>n</i> = 123; 46.9%). Blood cultures were positive in 95 (36.3%) patients, and 79 (83.2%) patients had monomicrobial growth. The 30-day, 90-day, and in-hospital mortality numbers were 3 (1.1%), 11 (4.2%), and 15 (5.7%), respectively. In multivariate analysis, type 2 diabetes mellitus (OR = 12.531; 95% CI 0.354–116.015; <i>p</i> = 0.026), systolic blood pressure &#x3c;100 mm Hg (OR = 10.108; 95% CI 1.094–93.395; <i>p</i> = 0.041), Glasgow coma score &#x3c;15 (OR = 38.16; 95% CI 1.804–807.191; <i>p</i> = 0.019), and malignancy (OR = 14.135; 95% CI 1.017–196.394; <i>p</i> = 0.049) predicted in-hospital mortality. <b><i>Conclusion:</i></b> TG13/18 diagnostic criteria are more sensitive than TG07 diagnostic criteria. Type 2 diabetes mellitus, systolic blood pressure &#x3c;100 mm Hg, Glasgow coma score &#x3c;15, and malignant etiology predict in-hospital mortality in patients with AC. These predictors could be considered in acute stratification and treatment of patients with AC.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ana María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441


2021 ◽  
Vol 160 (6) ◽  
pp. S-391-S-392
Author(s):  
Ahmad Alkaddour ◽  
Amit Hudgi ◽  
Anabel Liyen Cartelle ◽  
Amr Ahmed ◽  
Carlos Palacio ◽  
...  

2021 ◽  
Author(s):  
Hanyu Zhang ◽  
Zhaoqing Lu ◽  
Guoxing Wang ◽  
Di Wu ◽  
Xu Ge ◽  
...  

Abstract Background: Presepsin is currently a promising biomarker for the early diagnosis and prognosis of acute bacterial infection. Acute cholangitis is caused by bacterial infection and has high morbidity and mortality. The study engaged to assess the grading and prognostic value of presepsin in patients with acute cholangitis. Methods: This study enrolled patients with acute cholangitis in the emergency department from May 1, 2019 to December 20, 2020. The patients were evaluated for severity by the 2018 Tokyo Guidelines for Acute Cholangitis. Patients’ baseline features and routine clinical data were collected. On admission, presepsin, procalcitonin (PCT) and systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores were determined; and blood cultures were performed. IBM SPSS software (version 22.0) was used. The comparation of values was performed by Pearson chi-square test or Fisher's exact test or Mann-Whitney U test. The area under the receiver operating characteristic curve (AUC), multivariate logistic regression, and correlation analysis were used to analyze this importance of determining the presepsin levels on admission for acute cholangitis. Results: In total, 330 patients, including 109, 101, and 120 patients classified as having mild, moderate, and severe cholangitis, respectively, were examined. The AUCs of presepsin were 0.713 in predicting severe acute cholangitis, better than those of white blood cell (WBC 0.411), C-reactive protein (CRP 0.615), PCT 0.608, and total bilirubin (T-Bil 0.441) (P<0.05). The AUC of presepsin in predicting 28-day mortality was higher than that of WBC, CRP, PCT, and T-Bil. The presepsin level in the positive blood culture group was higher than that in the negative blood culture group (P=0.000). The P values for correlations of presepsin with SIRS and SOFA scores were 0.002 and 0.000, respectively. Conclusions: Presepsin levels on admission were correlated with SIRS and SOFA scores. Presepsin may predict positive blood culture and 28-day mortality in patients with acute cholangitis, and it is superior to WBC, CRP, PCT, and T-Bil in the risk stratification and prognostic assessment of severe cholangitis. Trial registration: Ethical code of this study is 2018-P2-063-01 and acquired on May, 22, 2018.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matteo Barabino ◽  
Gaetano Piccolo ◽  
Arianna Trizzino ◽  
Veronica Fedele ◽  
Carlo Ferrari ◽  
...  

Abstract Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.


2021 ◽  
Author(s):  
Ana-María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  

Abstract Background: Acute Calculous Cholecystitis (ACC) is the second most frequent surgical condition in Emergency Departments. The recommended treatment is the Early Laparoscopic Cholecystectomy, however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patients for surgical treatment. The objective of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification.Methods: retrospective unicentric cohort study of patients emergently admitted with and ACC during January 1, 2011 to December 31, 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confunding factors comparing surgical treatment and non-surgical treatment.Results: the overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66:95%CI: 1.7-12.8 P=0.001), dementia (OR 4.12;95%CI: 1.34-12.7 P=0.001), age > 80 years (OR 1.12:95% CI: 1.02-1.21 P=0.001) and the need of preoperative vasoactive amines (OR 9.9:95%CI: 3.5-28.3 P=0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P=0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%).Conclusions: mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME could allow us to create a new alternative guideline to TG for treating ACC.Trial Registration: retrospectively registered and recorded in Clinical Trials (NTC 0474441).


Export Citation Format

Share Document