{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:22:23Z","timestamp":1791638543995,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,1,11]],"date-time":"2013-01-11T00:00:00Z","timestamp":1357862400000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We propose a management strategy for acute cholangitis and cholecystitis according to the severity assessment. For Grade I (mild) acute cholangitis, initial medical treatment including the use of antimicrobial agents may be sufficient for most cases. For non\u2010responders to initial medical treatment, biliary drainage should be considered. For Grade II (moderate) acute cholangitis, early biliary drainage should be performed along with the administration of antibiotics. For Grade III (severe) acute cholangitis, appropriate organ support is required. After hemodynamic stabilization has been achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. In patients with Grade II (moderate) and Grade III (severe) acute cholangitis, treatment for the underlying etiology including endoscopic, percutaneous, or surgical treatment should be performed after the patient's general condition has been improved. In patients with Grade I (mild) acute cholangitis, treatment for etiology such as endoscopic sphincterotomy for choledocholithiasis might be performed simultaneously, if possible, with biliary drainage. Early laparoscopic cholecystectomy is the first\u2010line treatment in patients with Grade I (mild) acute cholecystitis while in patients with Grade II (moderate) acute cholecystitis, delayed\/elective laparoscopic cholecystectomy after initial medical treatment with antimicrobial agent is the first\u2010line treatment. In non\u2010responders to initial medical treatment, gallbladder drainage should be considered. In patients with Grade III (severe) acute cholecystitis, appropriate organ support in addition to initial medical treatment is necessary. Urgent or early gallbladder drainage is recommended. Elective cholecystectomy can be performed after the improvement of the acute inflammatory process.<\/jats:p>","DOI":"10.1007\/s00534-012-0563-1","type":"journal-article","created":{"date-parts":[[2013,1,10]],"date-time":"2013-01-10T16:43:39Z","timestamp":1357836219000},"page":"47-54","source":"Crossref","is-referenced-by-count":214,"title":["TG13 flowchart for the management of acute cholangitis and cholecystitis"],"prefix":"10.1002","volume":"20","author":[{"given":"Fumihiko","family":"Miura","sequence":"first","affiliation":[{"name":"Department of Surgery Teikyo University School of Medicine  2\u201011\u20101, Kaga, Itabashi\u2010ku Tokyo 173\u20108605 Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadahiro","family":"Takada","sequence":"additional","affiliation":[{"name":"Department of Surgery Teikyo University School of Medicine  2\u201011\u20101, Kaga, Itabashi\u2010ku Tokyo 173\u20108605 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":"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. 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