Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

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Abstract

<p class="first" id="d4967535e951">Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. 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. </p>

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Most cited references 43

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Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos).

Takao Itoi, Kenneth Binmoeller, Janak Shah … (2012)

Tubular plastic and metal stents have inherent shortcomings when used for transenteric drainage of fluid collections. To evaluate a novel lumen-apposing, self-expandable metal stent for EUS-guided drainage of pancreatic pseudocysts and the gallbladder. Retrospective case series. Tertiary-care academic medical center. This study involved 15 patients (median age 54 years) with symptomatic pancreatic pseudocysts who underwent 12 transgastric and 3 transduodenal pseudocyst drainage procedures. Five patients (median age 69.5 years) with acute cholecystitis underwent 4 cholecystoduodenostomies and 1 cholecystogastostomy. Stent deployment under EUS guidance, passage of an endoscope through the stent lumen for pseudocystoscopy or cholecystoscopy, transenteric endoscopy-guided interventions including biopsy, necrosectomy, and stone removal. Technical and clinical success. All stents were successfully deployed without complication, with a median time to removal of 35 days. All pseudocysts resolved after a single drainage procedure. One stent migrated into the stomach, and the remaining 14 were found to be patent at the time of removal. There was no pseudocyst recurrence during the 11.4-month median follow-up period. One gallbladder stent remains indwelling and fully patent at 12 months. Resolution of acute cholecystitis was observed immediately after stent implantation. No recurrence of symptoms was observed during a median follow-up period of 9 months. Retrospective study, small sample size, lack of control patients. Transenteric drainage of pancreatic pseudocysts and the gallbladder by using a novel, lumen-apposing, metal stent was accomplished with high technical and clinical success in this pilot observational study. Further studies are warranted. Copyright Â© 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

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Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions.

Indravadan J Patel, Jon Davidson, Boris Nikolic … (2012)

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TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis.

Tadahiro Takada, Steven M. Strasberg, Joseph Solomkin … (2013)

In 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were first published in the Journal of Hepato-Biliary-Pancreatic Surgery. The fundamental policy of TG07 was to achieve the objectives of TG07 through the development of consensus among specialists in this field throughout the world. Considering such a situation, validation and feedback from the clinicians' viewpoints were indispensable. What had been pointed out from clinical practice was the low diagnostic sensitivity of TG07 for acute cholangitis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. In June 2010, we set up the Tokyo Guidelines Revision Committee for the revision of TG07 (TGRC) and started the validation of TG07. We also set up new diagnostic criteria and severity assessment criteria by retrospectively analyzing cases of acute cholangitis and cholecystitis, including cases of non-inflammatory biliary disease, collected from multiple institutions. TGRC held meetings a total of 35 times as well as international email exchanges with co-authors abroad. On June 9 and September 6, 2011, and on April 11, 2012, we held three International Meetings for the Clinical Assessment and Revision of Tokyo Guidelines. Through these meetings, the final draft of the updated Tokyo Guidelines (TG13) was prepared on the basis of the evidence from retrospective multi-center analyses. To be specific, discussion took place involving the revised new diagnostic criteria, and the new severity assessment criteria, new flowcharts of the management of acute cholangitis and cholecystitis, recommended medical care for which new evidence had been added, new recommendations for gallbladder drainage and antimicrobial therapy, and the role of surgical intervention. Management bundles for acute cholangitis and cholecystitis were introduced for effective dissemination with the level of evidence and the grade of recommendations. GRADE systems were utilized to provide the level of evidence and the grade of recommendations. TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates adapted for clinical practice. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The bundles for the management of acute cholangitis and cholecystitis are presented in a separate section in TG13. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.

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Author and article information

Journal

Title: Journal of Hepato-Biliary-Pancreatic Sciences

Abbreviated Title: J Hepatobiliary Pancreat Sci

Publisher: Wiley

ISSN: 18686974

Publication date Created: January 2018

Publication date (Print): January 2018

Publication date (Electronic): November 21 2017

Volume: 25

Issue: 1

Pages: 87-95

Affiliations

[1 ]Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan

[2 ]Department of Gastroenterology and Hepatology; Tokyo Medical University Hospital; Tokyo Japan

[3 ]Division of Gastroenterology and Hepatology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA

[4 ]Department of Surgery; Teikyo University School of Medicine; Tokyo Japan

[5 ]Section of Hepato-Pancreato-Biliary Surgery; Washington University School of Medicine; St. Louis Missouri USA

[6 ]Lewis Katz School of Medicine at Temple University; Philadelphia Pennsylvania USA

[7 ]Department of Family Medicine; Mie Prefectural Ichishi Hospital; Mie Japan

[8 ]Director; Mie Prefectural Ichishi Hospital; Mie Japan

[9 ]Department of General Internal Medicine; Japanese Red Cross Nagoya Daini Hospital; Aichi Japan

[10 ]Department of Surgery; The Chinese University of Hong Kong; Shatin Hong Kong

[11 ]Department of Gastroenterology; University of Ulsan College of Medicine; Seoul Korea

[12 ]Department of Surgery; Mayo Clinic College of Medicine; Florida USA

[13 ]Department of Gastroenterological Surgery; Yokohama City University Graduate School of Medicine; Kanagawa Japan

[14 ]Department of Surgery; Center for Gastroenterology and Liver Disease; Kitakyushu City Yahata Hospital; Fukuoka Japan

[15 ]Department of Surgery; Fujinomiya City General Hospital; Shizuoka Japan

[16 ]Minimally Invasive Surgery Center; Yotsuya Medical Cube; Tokyo Japan

[17 ]Department of Gastroenterological and Pediatric Surgery; Oita University; Faculty of Medicine; Oita Japan

[18 ]Department of Surgery; Keio University School of Medicine; Tokyo Japan

[19 ]Department of Surgery; Ageo Central General Hospital; Saitama Japan

[20 ]Department of Surgery; Seoul National University Bundang Hospital; Seoul National University College of Medicine; Seoul Korea

[21 ]Department of Surgery; Konyang University Hospital; Daejeon Korea

[22 ]Division of General Surgery; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan

[23 ]Clinical Surgery; University of Edinburgh; Edinburgh UK

[24 ]Department of Hepato-Pancreato-Biliary Surgery; Hospital Selayang; Malaysia

[25 ]Liau KH Consulting PL; Mt Elizabeth Novena Hospital; Singapore& Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore

[26 ]Department of Surgery; Show Chwan Memorial Hospital; Changhua Taiwan

[27 ]Department of Surgery; Academic Medical Center; Amsterdam The Netherlands

[28 ]Department of General and HPB Surgery; Loreto Nuovo Hospital; Naples Italy

[29 ]First Department of Surgery; Agia Olga Hospital; Athens Greece

[30 ]Department of Surgery, Hospital Italiano; University of Buenos Aires; Buenos Aires Argentina

[31 ]Chair of General Surgery and Minimal Invasive Surgery “Taquini”; University of Buenos Aires Argentina; DAICIM Foundation; Argentina

[32 ]Department of Surgery; The University of Auckland; Auckland New Zealand

[33 ]Faculty of Medicine; The Chinese University of Hong Kong; Shatin Hong Kong

[34 ]Hepatobiliary Center; Paul Brousse Hospital; Villejuif France

[35 ]Department of Surgical Oncology; Lilavati Hospital and Research Centre; Mumbai India

[36 ]Department of Surgical Gastroenterology; Seth G S Medical College and K E M Hospital; Mumbai India

[37 ]Department of Surgery; Cheng Hsin General Hospital; Taipei Taiwan

[38 ]Department of Surgery; Rush University Medical Center; Chicago Illinois USA

[39 ]Hepatic Surgery Centre; Department of Surgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China

[40 ]Department of Surgery; The University of Hong Kong; Queen Mary Hospital; Hong Kong Hong Kong

[41 ]Department of Surgery; Yuan's General Hospital; Kaohsiung Taiwan

[42 ]Surgical Gastroenterology/Hepatopancreatobiliary Unit; University of Cape Town and Groote Schuur Hospital; Cape Town South Africa

[43 ]Division of Surgical and Specialty Services; Flinders Medical Centre; Adelaide Australia

[44 ]Department of Surgery; Tokyo Metropolitan Komagome Hospital; Tokyo Japan

[45 ]Department of Surgery; Fujita Health University School of Medicine; Aichi Japan

[46 ]Department of Surgery; Toho University Ohashi Medical Center; Tokyo Japan

[47 ]Department of Surgery; Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan

[48 ]Department of Hemodialysis and Surgery; Chemotherapy Research Institute Kaken Hospital; International University of Health and Welfare; Chiba Japan

[49 ]Department of EBM and Guidelines; Japan Council for Quality Health Care; Tokyo Japan

[50 ]Department of Emergency Medicine; School of Medicine; University of Occupational and Environmental Health; Fukuoka Japan

[51 ]Department of Surgery; JR Sapporo Hospital; Hokkaido Japan

[52 ]Director; Toho University; Tokyo Japan

[53 ]Department of Gastroenterology; Second Teaching Hospital; Fujita Health University; Aichi Japan

Article

DOI: 10.1002/jhbp.504

PubMed ID: 28888080

SO-VID: 7721ca3b-5bb0-4955-9e30-cff5be0a557c

License:

http://doi.wiley.com/10.1002/tdm_license_1.1

http://onlinelibrary.wiley.com/termsAndConditions#vor

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