Hudgi Amit, Cartelle Anabel L, Ahmed Amr, Alkaddour Ahmad, Palacio Carlos, Vega Kenneth J, Yap John Erikson L
Internal Medicine, Medical College of Georgia - Augusta University, Augusta, USA.
Gastroenterology and Hepatology, Medical College of Georgia - Augusta University, Augusta, USA.
Cureus. 2022 Jul 31;14(7):e27527. doi: 10.7759/cureus.27527. eCollection 2022 Jul.
Background Acute cholangitis results in significant mortality unless treated promptly. The diagnostic grading criteria of the 2018 Tokyo Guidelines (TG18) are used worldwide as the standard for acute cholangitis (AC) management but validation in clinical practice is required. Aim Use of the Tokyo 2018 (TG18) guidelines in improving the diagnostic accuracy and early detection of AC compared to fellow clinical assessment. Methods A retrospective review of patient records from 1/2010-9/2019 seen at Augusta University - Medical College of Georgia with the International Classification of Diseases, Ninth Revision (ICD-9) code "cholangitis" and/or ICD-10 codes "acute cholangitis, other cholangitis, and calculus of bile duct with cholangitis" was performed. Inclusion criteria were gastroenterology inpatient consult fellow evaluation and clinical diagnosis of AC. A definitive diagnosis of AC was determined following endoscopic retrograde cholangiopancreatography (ERCP). TG18 scoring for AC was then performed, categorized as either diagnostic/non-diagnostic, and compared to fellow clinical assessments following definitive diagnosis post-ERCP. Data were analyzed with chi-square testing. Results Two hundred six patients were identified using ICD codes. Ninety-one met inclusion criteria and were analyzed. The mean patient age of the overall group was 67 years old (standard deviation of 13.3 years) with males comprising 69% and non-Hispanic white 56% of the study group. TG18 criteria assessment had a sensitivity of 86% and specificity of 63% for patients with AC post ERCP (p <0.05). TG18 accuracy was 81%. In comparison, fellow clinical suspicion had a sensitivity of 90.3% and specificity of 0% (NS). Fellow accuracy was 71%. No difference in fellows' diagnosis of suspected AC was noted based on the training year. Conclusion Application of the TG18 criteria for AC reduces the false positive rate and improves diagnostic accuracy, thus decreasing costs along with avoiding unnecessary ERCPs with associated complications.
急性胆管炎若不及时治疗会导致显著的死亡率。2018年东京指南（TG18）的诊断分级标准在全球范围内被用作急性胆管炎（AC）管理的标准，但仍需在临床实践中进行验证。目的：与临床评估相比，使用2018年东京（TG18）指南提高AC的诊断准确性和早期检测率。方法：对2010年1月至2019年9月在奥古斯塔大学-佐治亚医学院就诊的患者记录进行回顾性研究，这些患者的国际疾病分类第九版（ICD-9）编码为“胆管炎”和/或ICD-10编码为“急性胆管炎、其他胆管炎以及伴有胆管炎的胆管结石”。纳入标准为胃肠病学住院会诊、AC的同伴评估和临床诊断。在内镜逆行胰胆管造影（ERCP）后确定AC的明确诊断。然后对AC进行TG18评分，分为诊断性/非诊断性，并与ERCP后明确诊断后的同伴临床评估进行比较。数据采用卡方检验进行分析。结果：使用ICD编码确定了206例患者。91例符合纳入标准并进行了分析。整个组的平均患者年龄为67岁（标准差为13.3岁），男性占研究组的69%，非西班牙裔白人占56%。ERCP后AC患者的TG18标准评估敏感性为86%，特异性为63%（p<0.05）。TG18的准确性为81%。相比之下，同伴临床怀疑的敏感性为90.3%，特异性为0%（无显著性差异）。同伴的准确性为71%。根据培训年份，同伴对疑似AC的诊断没有差异。结论：应用TG18标准诊断AC可降低假阳性率，提高诊断准确性，从而降低成本，同时避免不必要的ERCP及其相关并发症。
