Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Abstract

Background The collaborative multicenter retrospective study of acute cholecystitis (AC) was performed in Japan and Taiwan. The aim for this study was evaluation of the clinical value of TG13 severity grading for AC. Method The study was designed as an international multicenter retrospective study of AC from 2011 to 2013. Based on the data, we investigated the TG13 severity grading by analyzing the correlations between grade and prognosis, surgical procedures, histopathology, and organ dysfunction and prognosis. Results An investigation revealed that 30-day overall mortality rate was 1.1% for Grade I, 0.8% for Grade II, 5.4% for Grade III. The mortality rate for Grade III was significantly higher than lower grades (P < 0.001). The greater the number of organ dysfunction, the higher the mortality rate (P < 0.001). However, the mortality rate varied depending on the number of organ dysfunction (3.1-25%). With respect to the surgical procedures, laparoscopic cholecystectomy was performed for Grade I patients (P < 0.001), and the higher the grade, the more likely open surgery would be selected (P < 0.001). Conclusion TG13 severity grading criteria for AC are providing great benefits in actual clinical settings. From this study, the position of each severity grade was obviously confirmed.

The impact of delayed source control and antimicrobial therapy in 196 patients with cholecystitis-associated septic shock: a cohort analysis

“…18,19 In patients with acute cholecystitis with associated organ dysfunction, Yokoe and colleagues reported in a multicentre study that mortality ranged from 3.1% to 25% depending on the number of organ failures present. 20 Anderson and colleagues reported in a multicentre database study of patients with acalculous cholecystitis that sepsis had a hazard ratio (HR) of 1.72 and shock had an HR of 2.07 for mortality. 21 Despite these studies, there is still a lack of data pertaining to cholecystitis-associated septic shock.…”

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)

“…Data from over 5,000 patients with acute cholecystitis in that study were then used to describe patient characteristics, treatment status, and the status of use of the TG13 diagnostic criteria and severity grading in clinical practice, and this was published as a descriptive study . A large‐scale validation of the TG13 severity grading of acute cholecystitis was then carried out on the basis of those results , providing evidence for the current revisions. The inclusion of validation by “big data” in revision work on guidelines is far from common, but the work of revising TG18 can justly be said to be proceeding on the basis of clinical data.…”

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

“…Although standard treatment for patients with acute cholecystitis (AC) is well established based on the 2007 Tokyo Guidelines (TG07) , revised in Tokyo Guidelines 2013 (TG13) , morbidity and mortality rates in patients at high risk for surgery with comorbid medical conditions remain high . In TG07, the detailed procedure of percutaneous transhepatic gallbladder drainage (PTGBD) was introduced, while the recommendation of PTGBD for AC was not established.…”