Abstract
Diagnostic criteria for acute cholangitis and cholecystitis in the TOKYO guidelines for the management of acute cholangitis and cholecystitis (TG2007) were verified with clinical cases. 1) Acute cholangitis. Diagnostic criteria in TG2007 were applied to 201 patients with symptomatic choledocholithiasis. The diagnostic sensitivity of TG2007 for definitive acute cholangitis was 70.1%. Its sensitivity is not acceptable as the diagnostic criteria of a life-threatening disease because the grouping of diagnostic criteria is inappropriate. In particular, the sensitivity was reduced by the fact that two or more of four items that added biliary history to Charcot's triad are necessary to diagnosis of acute cholangitis. 2) Acute cholecystitis. The diagnostic criteria in TG2007 were applied to 155 patients with acute cholecystitis found at surgery. The diagnostic sensitivity of TG2007 was 88.4%, so the sensitivity of these guidelines is excellent. However, the expression of a definite diagnosis is not clear. It is not concretely presented when acute cholecystitis is suspected clinically. The diagnostic criteria for acute cholangitis and cholecystitis in TG2007 have some problems and should be revised in order to improve their quality.
