Clinical Perspectives on the Current JPN Guidelines for the Management of Acute Cholangitis and Acute Cholecystitis

Abstract

Current JPN guidelines for the management of acute cholangitis and acute cholecystitis represent the clinical standards for the diagnostic criteria, severity assessment and treatment of acute cholangitis and acute cholecystitis. The severity of acute cholangitis is classified into three grades, mild, moderate, and severe. In the practical clinical setting, it is important to identify patients with moderate cholangitis who should receive biliary drainage as soon as possible. However, the criteria of moderate cholangitis contain jaundice (T. Bil > 2.0 mg ⁄dl) that is one of the diagnostic criteria for acute cholangitis itself. Therefore, there difficulties can arise when attempting to distinguishing moderate from mild cholangitis. The principal management of acute cholecystitis is early or urgent cholecystectomy. On the other hand, percutaneous transhepatic gallbladder drainage (PTGBD) is recommended for patients with moderate or severe disease and with surgical risk. In practice, treatment of acute cholecystitis has been regarded as treatment for cholelithiasis with symptoms of cholecystitis. PTGBD may be of value for patients with acalculous cholecystitis or cholecystitis but without detectable gallstone at the time of diagnosis. In addition, it may be useful for the treatment of choledocholithiasis with acute cholecystitis.