{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:34:27Z","timestamp":1790775267588,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T00:00:00Z","timestamp":1640044800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["837001506"],"award-info":[{"award-number":["837001506"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Acute cholangitis is an infection requiring endoscopic retrograde cholangiopancreatography (ERCP) and antibiotics. Several diagnostic tools help to diagnose cholangitis. Because diagnostic performance of these tools has not been studied and might therefore impose unnecessary ERCPs, we aimed to evaluate this.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We established a nationwide prospective cohort of patients with suspected biliary obstruction who underwent an ERCP. We assessed the diagnostic performance of Tokyo Guidelines (TG18), Dutch Pancreatitis Study Group (DPSG) criteria, and Charcot triad relative to real\u2010world cholangitis as the reference standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>127 (16%) of 794 patients were diagnosed with real\u2010world cholangitis. Using the TG18, DPSG, and Charcot triad, 345 (44%), 55 (7%), and 66 (8%) patients were defined as having cholangitis, respectively. Sensitivity for TG18 was 82% (95% CI 74\u201088) and specificity 60% (95% CI 56\u201063). The sensitivity for DPSG and Charcot was 42% (95% CI 33\u201051) and 46% (95% CI 38\u201056), specificity was 99.7% (95% CI 99\u2010100) and 99% (95% CI 98\u2010100), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TG18 criteria incorrectly diagnoses four out of ten patients with real\u2010world cholangitis, while DPSG and Charcot criteria failed to diagnose more than half of patients. As the cholangitis diagnosis has many consequences for treatment, there is a need for more accurate diagnostic tools or work\u2010up towards ERCP.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhbp.1096","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T14:52:09Z","timestamp":1638975129000},"page":"479-486","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Performance of diagnostic tools for acute cholangitis in patients with suspected biliary obstruction"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6124-6256","authenticated-orcid":false,"given":"Christina J.","family":"Sperna Weiland","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Radboudumc  Nijmegen The Netherlands"},{"name":"Department of Research and Development St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celine B. E.","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Research and Development St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abha","family":"Bhalla","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Hagaziekenhuis  The Hague The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco J.","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus Medical Centre  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Fockens","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam Gastroenterology Endocrinology Metabolism Amsterdam UMC  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanin E.","family":"van Hooft","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Leiden University medical Centre  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander C.","family":"Poen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Isala Clinics  Zwolle The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5714-4951","authenticated-orcid":false,"given":"Hester C.","family":"Timmerhuis","sequence":"additional","affiliation":[{"name":"Department of Research and Development St. Antonius Hospital  Nieuwegein The Netherlands"},{"name":"Department of Surgery St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devica S.","family":"Umans","sequence":"additional","affiliation":[{"name":"Department of Research and Development St. Antonius Hospital  Nieuwegein The Netherlands"},{"name":"Department of Gastroenterology and Hepatology Amsterdam Gastroenterology Endocrinology Metabolism Amsterdam UMC  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels G.","family":"Venneman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Medisch Spectrum Twente  Enschede The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Verdonk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost P. H.","family":"Drenth","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Radboudumc  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"de Wijkerslooth","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Netherlands Cancer Institute \u2010 Antoni van Leeuwenhoek hospital  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwin J. M.","family":"van Geenen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Radboudumc  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Dutch Pancreatitis Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-006-1156-7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.4291\/wjgp.v9.i1.1"},{"issue":"2","key":"e_1_2_8_4_1","first-page":"141","article-title":"Acute suppurative cholangitis, a medical and surgical emergency. 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