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    Evaluating the Relevance of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis.

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    Tokyo Guidelines.pdf
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    Author
    Joseph, Bellal
    Jehan, Faisal
    Dacey, Michael
    Kulvatunyou, Narong
    Khan, Muhammad
    Zeeshan, Muhammad
    Gries, Lynn
    O'Keeffe, Terence
    Riall, Taylor S
    Affiliation
    Univ Arizona, Coll Med, Div Trauma Crit Care Emergency Surg & Burns, Tucson, AZ USA
    Univ Arizona, Coll Med, Dept Surg, Tucson, AZ USA
    Issue Date
    2018-07-01
    
    Metadata
    Show full item record
    Publisher
    ELSEVIER SCIENCE INC
    Citation
    Joseph, B., Jehan, F., Dacey, M., Kulvatunyou, N., Khan, M., Zeeshan, M., ... & Riall, T. S. (2018). Evaluating the Relevance of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis. Journal of the American College of Surgeons.
    Journal
    Journal of American College of Surgeons
    Rights
    © 2018 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    The 2013 Tokyo Guidelines (TG13) are used to diagnose, grade severity, and guide management of acute cholecystitis (AC). The aim of our study was to verify the diagnostic criteria, severity assessment, and management protocols based on the TG13. Our prospectively maintained emergency general surgery registry was used to review patients who had a surgical consultation for right upper quadrant pain (from 2013 to 2015). Diagnosis and severity were graded based on TG13 and compared with pathology reports. Our institutional management protocols were compared with TG13. Nine hundred and fifty-two patients were analyzed, of which 857 had biliary diseases. Mean age was 42 ± 18 years and 67% were female. Seven hundred and seventy-nine had a cholecystectomy, 15 underwent cholecystostomy tube placement, and 63 patients were managed conservatively. Only 4% were febrile on presentation and 51% of patients had leukocytosis. Fifty-nine percent of patients did not have any signs of AC on ultrasonography. The TG13 criteria had a sensitivity of 53% for diagnosing AC (definitive 27%, suspected 26%, and undiagnosed 47%) when compared with the final pathology report; 92.5% of patients with grade I, 93% with grade II, and even 64% with grade III, underwent cholecystectomy safely at our institute. There were no differences in complication rates (3.7% vs 4.7%; p = 0.81), return to operating room rates (0.6% vs 0.7%; p = 0.95), or mortality rates (0.3% vs 0%; p = 0.96) between grade I and grade II patients who underwent early cholecystectomy. The TG13 diagnostic criteria lack sensitivity and missed more than half of the patients with AC, as many patients lack clinical signs (fever and leukocytosis). The TG13 recommendations for conservative management and delayed cholecystectomy in grade II and grade III disease are not warranted.
    Note
    12 month embargo; published July 2018
    ISSN
    1072-7515
    EISSN
    1879-1190
    PubMed ID
    29580879
    DOI
    10.1016/j.jamcollsurg.2018.02.016
    Version
    Final accepted manuscript
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jamcollsurg.2018.02.016
    Scopus Count
    Collections
    UA Faculty Publications

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