Details

Autor(en) / Beteiligte

• Sun, Gang
• Han, Lu
• Yang, Yun-Sheng
• Linghu, En-Qiang
• Li, Wen
• Cai, Feng-Chun
• Kong, Jin-Yan
• Wang, Xiang-Dong
• Meng, Jiang-Yun
• Du, Hong
• Wang, Hong-Bin
• Huang, Qi-Yang
• Hyder, Quratulain
• Zhang, Xiu-Li

Titel

Verification of the Tokyo guidelines for acute cholangitis secondary to benign and malignant biliary obstruction:experience from a Chinese tertiary hospital

Ist Teil von

• Hepatobiliary & pancreatic diseases international, 2013-08, Vol.12 (4), p.400-407

Ort / Verlag

Singapore: Elsevier B.V

Erscheinungsjahr

2013

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• BACKGROUND: The lack of widely-accepted guidelines for acute cholangitis largely lags behind the progress in medical and surgical technology and science for the management of acute cholangitis. This study aimed to verify the Tokyo guidelines for the management of acute cholangitis and cholecystitis of 2007 edition (TG07) in patients with obstructive cholangitis due to benign and malignant diseases. METHODS: The patients were retrieved from our existing ERCP database. Final diagnosis of acute cholangitis was made by detecting purulent bile during biliary drainage. We examined and compared the guidelines concerning benign and malignant obstruction. RESULTS: In 120 patients in our study, 82 and 38 had benign and malignant biliary obstruction, respectively. Guidelines based diagnosis was made in 68 (82.9%), 36 (94.7%), and 104 (86.7%) patients with benign, malignant, and overall biliary obstruction, respectively, which were significantly higher than 44 (53.7%), 17 (44.7%), and 61 (50.8%) diagnosed by Charcot’s triad (P<0.001). Treatment consistent with the guidelines was offered to 58 (70.7%) patients with benign obstruction and15 (39.5%) patients with malignant obstruction (P=0.001). No significant association was observed between clinical compliance, guidelines-based severity grades and clinical outcomes. In the multivariate model, intrahepatic obstruction (OR=11.2, 95% CI: 1.55-226.9) and hypoalbuminemia (≤25.0 g/L; OR=17.3, 95% CI: 3.5-313.6) were independent risk factors for a 30-day mortality. CONCLUSIONS: The TG07 are more reliable than Charcot’s triad for the diagnosis of acute cholangitis albeit with limited prognostic values. Intrahepatic obstruction and hypoalbuminemia are new predictors of poor prognosis and need further assessment.