Abstract
We investigated the usefulness of both the Tokyo guidelines (TG) and JPN guidelines for acute cholangitis (AC). We prospectively reviewed 48 cases of AC and divided them into an emergency-ERCP group (Group A, n=18) and an elective-ERCP group (Group B, n=30). According to the TG, the AC was severe in 10 cases and moderate in 8 cases in Group A, and moderate in 8 cases and mild 22 cases in Group B, whereas based on the JPN guidelines the AC was severe in 13 cases, and moderate in 5 cases in Group A, and severe in 2 cases, moderate in 24 cases, and mild in 4 cases in Group B. The severity of AC tended to be overestimated based on the JPN guidelines in comparison with the TG. When the five predictors of moderate AC in the JPN guidelines were used to devise a scoring system, the ROC curve of the scores showed good test performance for predicting emergency ERCP and predicting severe AC in TG with an AUC of 0.87 and 0.97. We therefore concluded that the scoring system would contribute to identifying indications for emergency ERCP and predicting of severe AC.
