{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:37:50Z","timestamp":1789709870177,"version":"4.0.1"},"reference-count":17,"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>In 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were first published in the <jats:italic>Journal of Hepato\u2010Biliary\u2010Pancreatic Surgery<\/jats:italic>. The fundamental policy of TG07 was to achieve the objectives of TG07 through the development of consensus among specialists in this field throughout the world. Considering such a situation, validation and feedback from the clinicians' viewpoints were indispensable. What had been pointed out from clinical practice was the low diagnostic sensitivity of TG07 for acute cholangitis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. In June 2010, we set up the Tokyo Guidelines Revision Committee for the revision of TG07 (TGRC) and started the validation of TG07. We also set up new diagnostic criteria and severity assessment criteria by retrospectively analyzing cases of acute cholangitis and cholecystitis, including cases of non\u2010inflammatory biliary disease, collected from multiple institutions. TGRC held meetings a total of 35 times as well as international email exchanges with co\u2010authors abroad. On June 9 and September 6, 2011, and on April 11, 2012, we held three International Meetings for the Clinical Assessment and Revision of Tokyo Guidelines. Through these meetings, the final draft of the updated Tokyo Guidelines (TG13) was prepared on the basis of the evidence from retrospective multi\u2010center analyses. To be specific, discussion took place involving the revised new diagnostic criteria, and the new severity assessment criteria, new flowcharts of the management of acute cholangitis and cholecystitis, recommended medical care for which new evidence had been added, new recommendations for gallbladder drainage and antimicrobial therapy, and the role of surgical intervention. Management bundles for acute cholangitis and cholecystitis were introduced for effective dissemination with the level of evidence and the grade of recommendations. GRADE systems were utilized to provide the level of evidence and the grade of recommendations. TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates adapted for clinical practice. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The bundles for the management of acute cholangitis and cholecystitis are presented in a separate section in TG13.<\/jats:p>","DOI":"10.1007\/s00534-012-0566-y","type":"journal-article","created":{"date-parts":[[2013,1,10]],"date-time":"2013-01-10T15:54:48Z","timestamp":1357833288000},"page":"1-7","source":"Crossref","is-referenced-by-count":220,"title":["TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis"],"prefix":"10.1002","volume":"20","author":[{"given":"Tadahiro","family":"Takada","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":"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":"Harumi","family":"Gomi","sequence":"additional","affiliation":[{"name":"Center for Clinical Infectious Diseases Jichi Medical University  Tochigi 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":"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":"Fumihiko","family":"Miura","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":"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":"Seiki","family":"Kiriyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Ogaki Municipal Hospital  Ogaki Japan"}],"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":"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":"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":"Kohji","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery Kitakyushu Municipal Yahata Hospital  Kitakyushu 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":"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":"Shinya","family":"Kusachi","sequence":"additional","affiliation":[{"name":"Department of Surgery Toho University Medical Center Ohashi Hospital  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":"Avinash N.","family":"Supe","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology Seth G S Medical College and K E M Hospital  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  Seoul Korea"}],"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 Universty of Science &amp; 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