Year: 2013
Type: article
Abstract: We propose a management strategy for acute cholangitis and cholecystitis according to the severity assessment. For Grade I (mild) acute cholangitis, initial medical treatment including the use of antimicrobial agents may be sufficient for most cases. For non-responders to initial medical treatment, biliary drainage should be considered. For Grade II (moderate) acute cholangitis, early biliary drainage should be performed along with the administration of antibiotics. For Grade III (severe) acute cholangitis, appropriate organ support is required. After hemodynamic stabilization has been achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. In patients with Grade II (moderate) and Grade III (severe) acute cholangitis, treatment for the underlying etiology including endoscopic, percutaneous, or surgical treatment should be performed after the patient's general condition has been improved. In patients with Grade I (mild) acute cholangitis, treatment for etiology such as endoscopic sphincterotomy for choledocholithiasis might be performed simultaneously, if possible, with biliary drainage. Early laparoscopic cholecystectomy is the first-line treatment in patients with Grade I (mild) acute cholecystitis while in patients with Grade II (moderate) acute cholecystitis, delayed/elective laparoscopic cholecystectomy after initial medical treatment with antimicrobial agent is the first-line treatment. In non-responders to initial medical treatment, gallbladder drainage should be considered. In patients with Grade III (severe) acute cholecystitis, appropriate organ support in addition to initial medical treatment is necessary. Urgent or early gallbladder drainage is recommended. Elective cholecystectomy can be performed after the improvement of the acute inflammatory process. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
Authors: Fumihiko Miura, Tadahiro Takada, Steven M. Strasberg, Joseph S. Solomkin, Henry A. Pitt, Dirk J. Gouma, O. James Garden, Markus W. Büchler, Masahiro Yoshida, Toshihiko Mayumi, Kohji Okamoto, Harumi Gomi, Shinya Kusachi, Seiki Kiriyama, Masamichi Yokoe, Yasutoshi Kimura, Ryota Higuchi, Yuichi Yamashita, John A. Windsor, Toshio Tsuyuguchi, Toshifumi Gabata, Takao Itoi, Jiro Hata, Kui‐Hin Liau
Institutions: Teikyo University, Washington University in St. Louis, University of Cincinnati, University of Cincinnati Medical Center, Indiana University Indianapolis, Indiana University School of Medicine, Amsterdam UMC Location University of Amsterdam, University of Edinburgh, Heidelberg University, International University of Health and Welfare Ichikawa Medical Center, International University of Health and Welfare, Ichinomiya Municipal City Hospital, Kitakyushu City Hospital Organization, Kitakyushu City Yahata Hospital, Jichi Medical University, Toho University, Toho University Ohashi Medical Center, Ogaki Municipal Hospital, Japanese Red Cross Nagoya Daini Hospital, Sapporo Medical University, Institute of Gastroenterology, Tokyo Women's Medical University, Fukuoka University, University of Auckland, Chiba University, Kanazawa University, Tokyo Medical University, Kawasaki Medical School, Mount Elizabeth Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2064592991