@article{Miura201831,
title = {Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis},
author = {Fumihiko Miura and Kohji Okamoto and Tadahiro Takada and Steven M. Strasberg and Horacio J. Asbun and Henry A. Pitt and Harumi Gomi and Joseph S. Solomkin and David Schlossberg and Ho-Seong Han and Myung-Hwan Kim and Tsann-Long Hwang and Miin-Fu Chen and Wayne Shih-Wei Huang and Seiki Kiriyama and Takao Itoi and O. James Garden and Kui-Hin Liau and Akihiko Horiguchi and Keng-Hao Liu and Cheng-Hsi Su and Dirk J. Gouma and Giulio Belli and Christos Dervenis and Palepu Jagannath and Angus C. W. Chan and Wan Yee Lau and Itaru Endo and Kenji Suzuki and Yoo-Seok Yoon and Eduardo Santibañes and Mariano Eduardo Giménez and Eduard Jonas and Harjit Singh and Goro Honda and Koji Asai and Yasuhisa Mori and Keita Wada and Ryota Higuchi and Manabu Watanabe and Toshiki Rikiyama and Naohiro Sata and Nobuyasu Kano and Akiko Umezawa and Shuntaro Mukai and Hiromi Tokumura and Jiro Hata and Kazuto Kozaka and Yukio Iwashita and Taizo Hibi and Masamichi Yokoe and Taizo Kimura and Seigo Kitano and Masafumi Inomata and Koichi Hirata and Yoshinobu Sumiyama and Kazuo Inui and Masakazu Yamamoto},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85040723161&doi=10.1002%2fjhbp.509&partnerID=40&md5=78cdf4686bbd104bb457ac3e3ac210b0},
doi = {10.1002/jhbp.509},
issn = {18686974},
year = {2018},
date = {2018-01-01},
urldate = {2018-01-01},
journal = {Journal of Hepato-Biliary-Pancreatic Sciences},
volume = {25},
number = {1},
pages = {31 – 40},
publisher = {Blackwell Publishing Asia},
abstract = {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 a 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 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. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included. © 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery},
note = {Cited by: 153; All Open Access, Bronze Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
