Abstract
In 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were first published in the Journal of Hepato-Biliary-Pancreatic Surgery. Regarding acute cholecystitis, TG07 helped the spread of early laparoscopic cholecystectomy without gallbladder drainage. On the other hand, some surgeons have emphasized that routine early cholecystectomy may lead to an increased risk of biliary tract injury. These situations require a re-evaluation of gallbladder drainage for acute cholecystitis. Regarding acute cholangitis, recently single- or double-balloon enteroscopy-assisted biliary drainage (BE-BD) and endoscopic ultrasonography-guided biliary drainage (EUS-BD) have been reported as special techniques for biliary drainage. Thence, revised Tokyo Guidelines (TG13) have been prepared in accordance with the new evidence, and were released in January 2013 on the web. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) systems were utilized to provide the level of evidence and the grade of recommendations. This article presents the reason and evidence for the revision in the “Drainage for acute cholangitis, cholecystitis” of TG13.
