Harumi Gomi1, Tadahiro Takada2, Tsann-Long Hwang3, Kohei Akazawa4, Rintaro Mori5, Itaru Endo6, Fumihiko Miura2, Seiki Kiriyama7, Naohisa Matsunaga8, Takao Itoi9, Masamichi Yokoe10, Miin-Fu Chen3, Yi-Yin Jan3, Chen-Guo Ker11, Hsiu-Po Wang12, Keita Wada2, Hiroki Yamaue13, Masaru Miyazaki14, Masakazu Yamamoto15. 1. Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan. 2. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 3. Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan. 4. Department of medical informatics, Niigata University, Niigata, Japan. 5. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. 6. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 7. Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan. 8. Department of Infection Control and Prevention, Teikyo University, Tokyo, Japan. 9. Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan. 10. Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan. 11. Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan. 12. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. 13. Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan. 14. Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan. 15. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG07) and revised in 2013 (TG13). This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time. METHODS: This is an international multi-center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis by clinicians between 1 January 2011 and 31 December 2012 were enrolled. Those who met the diagnostic criteria of acute cholangitis by TG13 were statistically analyzed. RESULTS: A total of 7,294 patients were enrolled and 6,433 patients met the TG13 diagnostic criteria. The severity distribution was Grade I (37.5%), Grade II (36.2%), and Grade III (26.2%). The 30-day all-cause mortality was 2.4%, 4.7%, and 8.4% in Grade I, II, III severity, respectively (P < 0.001). The incidence of liver abscess and endocarditis as complications of acute cholangitis was 2.0% and 0.26%, respectively. CONCLUSIONS: This is the first large scale study to investigate patients with acute cholangitis. This study provides the basis to define the best practices to manage patients with acute cholangitis in future studies.
BACKGROUND: The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG07) and revised in 2013 (TG13). This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time. METHODS: This is an international multi-center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis by clinicians between 1 January 2011 and 31 December 2012 were enrolled. Those who met the diagnostic criteria of acute cholangitis by TG13 were statistically analyzed. RESULTS: A total of 7,294 patients were enrolled and 6,433 patients met the TG13 diagnostic criteria. The severity distribution was Grade I (37.5%), Grade II (36.2%), and Grade III (26.2%). The 30-day all-cause mortality was 2.4%, 4.7%, and 8.4% in Grade I, II, III severity, respectively (P < 0.001). The incidence of liver abscess and endocarditis as complications of acute cholangitis was 2.0% and 0.26%, respectively. CONCLUSIONS: This is the first large scale study to investigate patients with acute cholangitis. This study provides the basis to define the best practices to manage patients with acute cholangitis in future studies.