{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:53:37Z","timestamp":1792169617275,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2012,7,24]],"date-time":"2012-07-24T00:00:00Z","timestamp":1343088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The Tokyo Guidelines for the management of acute cholangitis and cholecystitis were published in 2007 (TG07) and have been widely cited in the world literature. Because of new information that has been published since 2007, we organized the Tokyo Guidelines Revision Committee to conduct a multicenter analysis to develop the updated Tokyo Guidelines (TG13).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods\/materials<\/jats:title><jats:p>We retrospectively analyzed 1,432 biliary disease cases where acute cholangitis was suspected. The cases were collected from multiple tertiary care centers in Japan. The \u2018gold standard\u2019 for acute cholangitis in this study was that one of the three following conditions was present: (1) purulent bile was observed; (2) clinical remission following bile duct drainage; or (3) remission was achieved by antibacterial therapy alone, in patients in whom the only site of infection was the biliary tree. Comparisons were made for the validity of each diagnostic criterion among TG13, TG07 and Charcot's triad.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The major changes in diagnostic criteria of TG07 were re\u2010arrangement of the diagnostic items and exclusion of abdominal pain from the diagnostic list. The sensitivity improved from 82.8 % (TG07) to 91.8 % (TG13). While the specificity was similar to TG07, the false positive rate in cases of acute cholecystitis was reduced from 15.5 to 5.9 %. The sensitivity of Charcot's triad was only 26.4 % but the specificity was 95.6 %. However, the false positive rate in cases of acute cholecystitis was 11.9 % and not negligible. As for severity grading, Grade II (moderate) acute cholangitis is defined as being associated with any two of the significant prognostic factors which were derived from evidence presented recently in the literature. The factors chosen allow severity assessment to be performed soon after diagnosis of acute cholangitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TG13 present a new standard for the diagnosis, severity grading, and management of acute cholangitis.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00534-012-0537-3","type":"journal-article","created":{"date-parts":[[2012,7,23]],"date-time":"2012-07-23T08:06:31Z","timestamp":1343030791000},"page":"548-556","source":"Crossref","is-referenced-by-count":147,"title":["New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines"],"prefix":"10.1002","volume":"19","author":[{"given":"Seiki","family":"Kiriyama","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Ogaki Municipal Hospital  4\u201086 Minaminokawa\u2010cho Ogaki Gifu 503\u20108502 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 Hepatobiliary and Pancreatic Surgery Washington University in Saint Louis School of Medicine  Saint Louis MO USA"}],"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":"Toshihiko","family":"Mayumi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine Ichinomiya Municipal Hospital  Ichinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry A.","family":"Pitt","sequence":"additional","affiliation":[{"name":"Department of Surgery Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk J.","family":"Gouma","sequence":"additional","affiliation":[{"name":"Department of Surgery Academic Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O. James","family":"Garden","sequence":"additional","affiliation":[{"name":"Clinical Surgery The University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus W.","family":"B\u00fcchler","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Heidelberg  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masamichi","family":"Yokoe","sequence":"additional","affiliation":[{"name":"General Internal Medicine Nagoya Daini Red Cross Hospital  Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutoshi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology and Gastroenterological Surgery Sapporo Medical University School of Medicine  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshio","family":"Tsuyuguchi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Clinical Oncology Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Clinical Research Center Kaken Hospital International University of Health and Welfare  Ichikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumihiko","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Surgery Teikyo University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Fukuoka University School of Medicine  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohji","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery Kitakyushu Municipal Yahata Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshifumi","family":"Gabata","sequence":"additional","affiliation":[{"name":"Department of Radiology Kanazawa University Graduate School of Medical Science  Kanazawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiro","family":"Hata","sequence":"additional","affiliation":[{"name":"Department of Endoscopy and Ultrasound Kawasaki Medical School  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Department of Surgery Institute of Gastroenterology Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Windsor","sequence":"additional","affiliation":[{"name":"Department of Surgery The University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippus C.","family":"Bornman","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Health Sciences University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheung\u2010Tat","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen Mary Hospital The University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harijt","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Pancreato\u2010Biliary Surgery Hospital Selayang  Batu caves Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"de Santibanes","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Italianio University of Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harumi","family":"Gomi","sequence":"additional","affiliation":[{"name":"Center for Clinical Infectious Diseases Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Kusachi","sequence":"additional","affiliation":[{"name":"Department of Surgery Toho University Medical Center Ohashi Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuhiko","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Community Health, School of Medicine University of Occupational and Environmental Health  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Ping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hepatic Surgery Centre, Tongji Hospital, Tongi Medical College Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palepu","family":"Jagannath","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Lilavati Hospital and Research Centre  Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Gyu","family":"Lee","sequence":"additional","affiliation":[{"name":"HepatoBiliary Surgery and Liver Transplantation, Asan Medical Center Ulsan University  Ulsan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Padbury","sequence":"additional","affiliation":[{"name":"Division of Surgical and Specialty Services Flinders Medical Centre  Bedford Park Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miin\u2010Fu","family":"Chen","sequence":"additional","affiliation":[{"name":"Chang Gung Memorial Hospital Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,7,24]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-006-1156-7"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-196902000-00015"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(76)90003-9"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198003000-00002"},{"key":"e_1_2_5_6_1","first-page":"369","article-title":"Clinical management of acute cholangitis","volume":"142","author":"Saharia PC","year":"1976","journal-title":"Surg Gynec Obstet."},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01656040"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-010-0338-5"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800790720"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/1994\/73139"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2001.01071.x"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198904000-00008"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198003000-00002"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199001000-00009"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01095.x"},{"key":"e_1_2_5_16_1","first-page":"47","article-title":"Abnormal pre\u2010drainage serum creatinine as a prognostic indicator in acute cholangitis","volume":"39","author":"Tai DI","year":"1992","journal-title":"HepatoGastroenterology"},{"key":"e_1_2_5_17_1","first-page":"141","article-title":"Acute suppurative cholangitis, a medical and surgical emergency. A review of ten years experience emphasizing early recognition","volume":"54","author":"Andrew DJ","year":"1970","journal-title":"Am J Gastroenterol."},{"key":"e_1_2_5_18_1","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1177\/000313480707301003","article-title":"Cholangitis: analysis of admission prognostic indicators and outcomes","volume":"73","author":"Rosing DK","year":"2007","journal-title":"Am Surg"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0891-5520(05)70119-7"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e3281532b78"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02469641"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl.2010.4.3.363"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.meg.0000219105.48058.df"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-006-1150-0"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198202000-00003"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1982.01380280031007"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1967.01330100024004"}],"container-title":["Journal of Hepato-Biliary-Pancreatic Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1007%2Fs00534-012-0537-3","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00534-012-0537-3","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1007\/s00534-012-0537-3","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00534-012-0537-3","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T18:44:08Z","timestamp":1694630648000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00534-012-0537-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,7,24]]},"references-count":26,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2012,9]]}},"alternative-id":["10.1007\/s00534-012-0537-3"],"URL":"https:\/\/doi.org\/10.1007\/s00534-012-0537-3","archive":["Portico"],"relation":{},"ISSN":["1868-6974","1868-6982"],"issn-type":[{"value":"1868-6974","type":"print"},{"value":"1868-6982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,7,24]]}}}