Clinical Evaluations of the Japanese Evidenced-Based Guidelines for Acute Cholangitis and Acute Cholecystitis and International Guidelines, the ‘Tokyo Guidelines for the Management of Acute Cholangitis and Cholecystitis’

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  • Yokoe Masamichi
    Department of General Internal Medicine, Nagoya Daini Red Cross Hospital
  • Mayumi Toshihiko
    Department of Emergency Medicine and Intensive Care, Nagoya University School of Medicine
  • Hasegawa Hiroshi
    Department of Surgery, Nagoya Daini Red Cross Hospital

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Other Title
  • 急性胆管炎・胆嚢炎診療ガイドラインとTokyo Guidelinesの臨床検討

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There are many differences between the Japanese Evidenced-Based Guidelines for acute cholangitis and cholecystitis and the International clinical guidelines for acute cholangitis and cholecystitis (‘Tokyo Guidelines’). The present study examines the differences of utility of both guidelines based on actual cases. The clinical records of 60 patients having a final clinical diagnosis of acute cholangitis and 80 patients having a final clinical diagnosis of acute cholecystitis before publication of the guidelines were retrospectively examined. On the acute cholangitis, the Japanese Guideline's diagnostic criteria were met by 91.7% patients above the suspected diagnosis. On the other hand, under the Tokyo Guideline's diagnostic criteria 75.0% met the criteria to be above the suspected diagnosis. Regarding the severity index, 9.1% of the patients were classed as mild, 87.3% as moderate, and 3.6% as severe based on the Japanese guideline. Based on the Tokyo Guidelines, 80.0% of the patients were classed as mild, 4.4% as moderate, and 15.6% as severe. For acute cholecystitis, under the Japanese Guideline's 87.5% of patients met the diagnostic criteria above the suspected diagnosis, compared with 85% who met the diagnostic criteria above the definite diagnosis under the Tokyo Guidelines. As for the severity index, 28.6% of the patients were classed as mild, 48.6% as moderate, and 22.8% as severe based on the Japanese guideline. Based on the Tokyo Guidelines, 48.5% of patients were classed as mild, 39.7% as moderate, and 11.8% as severe.

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