{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T08:28:30Z","timestamp":1793089710310,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,1,8]],"date-time":"2018-01-08T00:00:00Z","timestamp":1515369600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.jshbps.jp\/modules\/en\/index.php?content_id=47\">http:\/\/www.jshbps.jp\/modules\/en\/index.php?content_id=47<\/jats:ext-link>. Related clinical questions and references are also included.<\/jats:p>","DOI":"10.1002\/jhbp.509","type":"journal-article","created":{"date-parts":[[2017,9,23]],"date-time":"2017-09-23T14:26:39Z","timestamp":1506176799000},"page":"31-40","source":"Crossref","is-referenced-by-count":430,"title":["Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis"],"prefix":"10.1002","volume":"25","author":[{"given":"Fumihiko","family":"Miura","sequence":"first","affiliation":[{"name":"Department of Surgery Teikyo University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohji","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery Center for Gastroenterology and Liver Disease Kitakyushu City Yahata Hospital Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadahiro","family":"Takada","sequence":"additional","affiliation":[{"name":"Department of Surgery Teikyo University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Strasberg","sequence":"additional","affiliation":[{"name":"Section of Hepato\u2010Pancreato\u2010Biliary Surgery Washington University School of Medicine in St. Louis St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horacio J.","family":"Asbun","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic College of Medicine Jacksonville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry A.","family":"Pitt","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine at Temple University Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harumi","family":"Gomi","sequence":"additional","affiliation":[{"name":"Center for Global Health Mito Kyodo General Hospital University of Tsukuba Ibaraki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Solomkin","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cincinnati College of Medicine Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Schlossberg","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine at Temple University Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho\u2010Seong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Surgery Seoul National University Bundang Hospital Seoul National University College of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung\u2010Hwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University of Ulsan College of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsann\u2010Long","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of General Surgery Linkou Chang Gung Memorial Hospital Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miin\u2010Fu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery Show Chwan Memorial Hospital Changhua Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne Shih\u2010Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Surgery Show Chwan Memorial Hospital Changhua Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiki","family":"Kiriyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Ogaki Municipal Hospital Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O. 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