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<p>Tokyo Guidelines are evidence-based&#xa0;international guidelines used to diagnose, grade severity, and guide the management of acute cholecystitis, revised in 2013/2018. They are a combination of multiple clinical and investigation parameters. Conflicting studies regarding the usability and validity of Tokyo Guidelines 2018 led to no consensus being reached. To assess the relevance of Tokyo Guidelines 2018 diagnostic criteria and severity grading in a retrospective cohort from a single tertiary-care centre in India. One hundred fifty consecutive patients with right upper quadrant pain or suspicion of acute cholecystitis were admitted and managed as per our institutional protocols. Data was retrospectively collected. Grading of diagnosis and severity were based on Tokyo Guidelines 18, compared with pathology reports and treatment received. The data of 108 patients was analyzed (mean age was 44.68 years ± 12.62 SD and 79% were female). Forty-two patients were excluded. Eighty-three underwent laparoscopic-cholecystectomy, 8 open-cholecystectomy, 4 underwent cholecystostomy-tube placement, and 13 underwent medical management. Tokyo Guidelines 2018 showed 78.70% sensitivity for diagnosing acute cholecystitis. There was a significant (<i>p</i> &lt; 0.001, CI 95%) correlation between Tokyo Guidelines grading and the final pathology report. Tokyo Guidelines 2018 grade also correlated with the primary treatment received by the patient&#xa0;in this&#xa0;study (<i>p</i>-value &lt; 0.001, CI of 95%). Tokyo Guidelines 2018 predicted length-of-stay and likelihood of difficult surgery. Prior to this study, Tokyo Guidelines had not been evaluated or validated within the Indian population. Our research findings suggest that Tokyo Guidelines 2018 may be a useful tool in uniform diagnosis and management of acute cholecystitis in routine practice. However, further (prospective blinded) studies are necessary to confirm its reliability and generalizability&#xa0;across different populations.</p>

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A Retrospective Cohort Study to Assess the Significance of the Tokyo Guidelines-2018 for the Diagnosis and Management of Acute Cholecystitis

  • 期刊论文

  • 发表日期：

    2025年5月6日

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  • R. Sricharan,
  • H. K. Tejaswini

摘要

Tokyo Guidelines are evidence-based international guidelines used to diagnose, grade severity, and guide the management of acute cholecystitis, revised in 2013/2018. They are a combination of multiple clinical and investigation parameters. Conflicting studies regarding the usability and validity of Tokyo Guidelines 2018 led to no consensus being reached. To assess the relevance of Tokyo Guidelines 2018 diagnostic criteria and severity grading in a retrospective cohort from a single tertiary-care centre in India. One hundred fifty consecutive patients with right upper quadrant pain or suspicion of acute cholecystitis were admitted and managed as per our institutional protocols. Data was retrospectively collected. Grading of diagnosis and severity were based on Tokyo Guidelines 18, compared with pathology reports and treatment received. The data of 108 patients was analyzed (mean age was 44.68 years ± 12.62 SD and 79% were female). Forty-two patients were excluded. Eighty-three underwent laparoscopic-cholecystectomy, 8 open-cholecystectomy, 4 underwent cholecystostomy-tube placement, and 13 underwent medical management. Tokyo Guidelines 2018 showed 78.70% sensitivity for diagnosing acute cholecystitis. There was a significant (p < 0.001, CI 95%) correlation between Tokyo Guidelines grading and the final pathology report. Tokyo Guidelines 2018 grade also correlated with the primary treatment received by the patient in this study (p-value < 0.001, CI of 95%). Tokyo Guidelines 2018 predicted length-of-stay and likelihood of difficult surgery. Prior to this study, Tokyo Guidelines had not been evaluated or validated within the Indian population. Our research findings suggest that Tokyo Guidelines 2018 may be a useful tool in uniform diagnosis and management of acute cholecystitis in routine practice. However, further (prospective blinded) studies are necessary to confirm its reliability and generalizability across different populations.