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Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis
Author(s) -
Miura Fumihiko,
Okamoto Kohji,
Takada Tadahiro,
Strasberg Steven M.,
Asbun Horacio J.,
Pitt Henry A.,
Gomi Harumi,
Solomkin Joseph S.,
Schlossberg David,
Han HoSeong,
Kim MyungHwan,
Hwang TsannLong,
Chen MiinFu,
Huang Wayne ShihWei,
Kiriyama Seiki,
Itoi Takao,
Garden O. James,
Liau KuiHin,
Horiguchi Akihiko,
Liu KengHao,
Su ChengHsi,
Gouma Dirk J.,
Belli Giulio,
Dervenis Christos,
Jagannath Palepu,
Chan Angus C. W.,
Lau Wan Yee,
Endo Itaru,
Suzuki Kenji,
Yoon YooSeok,
Santibañes Eduardo,
Giménez Mariano Eduardo,
Jonas Eduard,
Singh Harjit,
Honda Goro,
Asai Koji,
Mori Yasuhisa,
Wada Keita,
Higuchi Ryota,
Watanabe Manabu,
Rikiyama Toshiki,
Sata Naohiro,
Kano Nobuyasu,
Umezawa Akiko,
Mukai Shuntaro,
Tokumura Hiromi,
Hata Jiro,
Kozaka Kazuto,
Iwashita Yukio,
Hibi Taizo,
Yokoe Masamichi,
Kimura Taizo,
Kitano Seigo,
Inomata Masafumi,
Hirata Koichi,
Sumiyama Yoshinobu,
Inui Kazuo,
Yamamoto Masakazu
Publication year - 2018
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.509
Subject(s) - medicine , biliary drainage , biliary tract , etiology , emergency department , surgery , intensive care medicine , psychiatry
The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for the definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy (EST) and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. This article is protected by copyright. All rights reserve