Abstract
Diagnostic criteria of acute cholangitis and cholecystitis in the Tokyo Guidelines (TG07) have been extensively used all over the world as the first standard. However, the clinical assessment of TG07 by means of multicenter analysis conducted by the TG07 Revision Committee showed some limits in these criteria. The TG07 diagnostic criteria of acute cholangitis have not enough diagnostic capacity as those of life-threating disease, due to the inappropriate combination of their diagnostic items., and so they have been revised as criteria to establish the diagnosis by cholestasis and inflammation based on clinical signs or blood test in addition to biliary manifestations based on imaging. The TG07 diagnostic criteria of acute cholecystitis had a good diagnostic capacity, but the criteria for a definitive diagnosis were ambiguous and unsuitable for clinical use. The definitive diagnosis was revised, as a clear and simple criterion based on imaging findings of acute cholecystitis in addition to suspected diagnosis by local and systemic inflammation signs based on clinical signs or blood tests. The revised diagnostic criteria for acute cholangitis and cholecystitis have better diagnostic capacity and are more suitable for clinical use than the TG07 criteria.
