Validating Tokyo Guidelines Criteria for Acute Cholecystitis

We retrospectively analyzed 451 patients from six tertiary care centers in Japan between November 2005 and November 2011: Sapporo Medical University, Tokyo Medical University, Tokyo Women’s Medical University, Nagoya Daini Red Cross Hospital, Ogaki Municipal Hospital, and Fukuoka University School of Medicine. Consecutive patients who were operated on for cholecystectomy were included during the study period. The “gold standard” for acute cholecystitis in this study was pathological diagnosis using standard gross and histological criteria. We therefore confirmed the final diagnosis by pathological examination of excised gallbladders after operation. If the pathological findings were chronic cholecystitis or other, those cases were considered to be “negative.”
All 451 patients were evaluated using TG07 criteria. The validity of the diagnostic criteria of TG07 was investigated by analyzing their sensitivity and specificity. The severity grading system of TG07 was evaluated by determining the distribution of severity among these patients. Through these data, the Tokyo Guidelines Revision Committee members discussed the quality of diagnostic criteria and severity assessment of acute cholecystitis in TG07 to reassess TG and propose new guidelines.
The literature was selected as follows: using “Tokyo Guidelines” AND “acute cholecystitis[MeSH]”, only 3 items were selected in PubMed since the publication of TG07 (1 April 2007 – 31 March 2012). These articles were screened with “human” and “English”. However, using “acute cholecystitis[MeSH]” AND “prognosis[MeSH]”, a total of 119 items were selected in PubMed over the same length of time. From these articles, the prognostic factors of acute cholecystitis to be utilized for the revision of TG07 were screened by the Tokyo Guidelines Revision Committee members. In addition, the distribution of severity grading was aggregated from the literature which reported the data based on the severity assessment of TG07.
The Tokyo Guidelines Revision Committee discussed the modification of TG07 diagnostic criteria and severity assessment of acute cholecystitis by analyzing the results of the present study and integrating the literature evidence.

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Yokoe M., Takada T., Strasberg S.M., Solomkin J.S., Mayumi T., Gomi H., Pitt H.A., Gouma D.J., Garden O.J., Büchler M.W., Kiriyama S., Kimura Y., Tsuyuguchi T., Itoi T., Yoshida M., Miura F., Yamashita Y., Okamoto K., Gabata T., Hata J., Higuchi R., Windsor J.A., Bornman P.C., Fan S.T., Singh H., de Santibanes E., Kusachi S., Murata A., Chen X.P., Jagannath P., Lee S., Padbury R, & Chen M.F. (2012). New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. Journal of Hepato-Biliary-Pancreatic Sciences, 19(5), 578-585.

Publication 2012

Acute cholecystitis Cholecystectomy Cholecystitis Committee members Diagnostic Gallbladders Gold Human Patients Patients centers care Prognosis Prognostic factors Women

Corresponding Organization : Japanese Red Cross Nagoya Daini Hospital

Other organizations : Teikyo University, Washington University in St. Louis, University of Cincinnati Medical Center, Ichinomiya Municipal City Hospital, Jichi Medical University, Indiana University – Purdue University Indianapolis, Academic Medical Center, University of Edinburgh, Heidelberg University, Ogaki Municipal Hospital, Sapporo Medical University, Chiba University, Tokyo Medical University, International University of Health and Welfare, Fukuoka University, Kitakyushu City Yahata Hospital, Kanazawa University, Kawasaki Medical School, Tokyo Women's Medical University, University of Auckland, University of Cape Town, Queen Mary Hospital, University of Hong Kong, Hospital Selayang, Hospital Italiano de Buenos Aires, University of Buenos Aires, Toho University, Toho University Ohashi Medical Center, University of Occupational and Environmental Health Japan, Huazhong University of Science and Technology, Tongji Hospital, Lilavati Hospital & Research Centre, Asan Medical Center, Flinders Medical Centre, Chang Gung University, Chang Gung Memorial Hospital

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Variable analysis

independent variables

Tokyo Guidelines 2007 (TG07) criteria for acute cholecystitis

dependent variables

Sensitivity of TG07 criteria for acute cholecystitis
Specificity of TG07 criteria for acute cholecystitis
Distribution of severity grades among patients based on TG07 severity assessment

control variables

Pathological diagnosis of excised gallbladders using standard gross and histological criteria as the 'gold standard' for acute cholecystitis

negative controls

Cases with pathological findings of chronic cholecystitis or other conditions were considered 'negative' for acute cholecystitis

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