Division of Gastroenterology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.
Gastrointest Endosc. 2021 Aug;94(2):297-302.e2. doi: 10.1016/j.gie.2021.04.016. Epub 2021 Apr 24.
Despite improvements in imaging and laboratory medicine, consensus criteria for the diagnosis of cholangitis are lacking. Although ERCP is an effective treatment for cholangitis, it should be reserved for those patients with a high probability of the diagnosis, given the morbidity associated with the procedure.
A comprehensive literature search of PubMed (from 1898 to present), Web of Science (1900 to July 15, 2019), Embase (1943 to July 15, 2019), and the Cochrane library (1898 to July 15, 2019) was performed to identify studies that reported on diagnostic paradigms and individual diagnostic parameters of cholangitis. This was used to identify domains associated with high probability of cholangitis.
We identified 23 observational studies (10,252 patients) that evaluated the performance of individual and combined criteria for the diagnosis of cholangitis. Traditional paradigms including Charcot's criteria and Ranson's criteria have inadequate sensitivity, and complexity has limited the implementation of the contemporary Tokyo criteria. Furthermore, controlled studies to validate diagnostic criteria for cholangitis are lacking. Existing literature suggests that 4 criteria, summarized by the acronym BILE, identifies those at high risk of cholangitis: Biliary imaging abnormalities or recent intervention, Inflammatory test abnormalities, Liver test abnormalities, and Exclusion of cholecystitis and acute pancreatitis.
There is a need for cholangitis diagnostic criteria that are supported by controlled validation studies, consistent with contemporary clinical values, and amenable to implementation. The BILE criteria are straightforward but require prospective study of their diagnostic performance and ability to avert unnecessary ERCP.
尽管影像学和实验室医学有所进步，但仍缺乏胆管炎的诊断共识标准。尽管 ERCP 是治疗胆管炎的有效方法，但鉴于该操作相关的发病率，应将其保留用于那些高度怀疑诊断的患者。
对 PubMed（从 1898 年至今）、Web of Science（1900 年至 2019 年 7 月 15 日）、Embase（1943 年至 2019 年 7 月 15 日）和 Cochrane 图书馆（1898 年至 2019 年 7 月 15 日）进行了全面的文献检索，以确定报告胆管炎诊断模式和单个诊断参数的研究。这用于确定与胆管炎高概率相关的领域。
我们确定了 23 项观察性研究（10252 名患者），这些研究评估了单个和联合标准用于诊断胆管炎的表现。传统范式，包括 Charcot 标准和 Ranson 标准，灵敏度不足，复杂性限制了当代东京标准的实施。此外，缺乏验证胆管炎诊断标准的对照研究。现有文献表明，4 个标准，用缩写 BILE 总结，可以识别那些患有胆管炎高风险的人：胆道成像异常或近期干预、炎症试验异常、肝脏试验异常以及排除胆囊炎和急性胰腺炎。
需要有经过对照验证研究支持的胆管炎诊断标准，符合当代临床价值观，易于实施。BILE 标准简单明了，但需要前瞻性研究其诊断性能和避免不必要的 ERCP 的能力。
