A multi‐institutional study designed by members of Tokyo Guidelines (<scp>TG</scp>) Core Meeting to elucidate the clinical characteristics and pathogenesis of acute cholangitis after bilioenteric anastomosis and biliary stent insertion with a focus on biliary obstruction: Role of transient hepatic attenuation difference (<scp>THAD</scp>) and pneumobilia in improving <scp>TG</scp> diagnostic performance-Reference-Cited by-同舟云学术

A multi‐institutional study designed by members of Tokyo Guidelines (TG) Core Meeting to elucidate the clinical characteristics and pathogenesis of acute cholangitis after bilioenteric anastomosis and biliary stent insertion with a focus on biliary obstruction: Role of transient hepatic attenuation difference (THAD) and pneumobilia in improving TG diagnostic performance

Published:2023-10-26 Issue:1 Volume:31 Page:12-24
ISSN:1868-6974
Container-title:Journal of Hepato-Biliary-Pancreatic Sciences
language:en
Short-container-title:J Hepato Biliary Pancreat

Author:

Kato Hiroyuki¹^ORCID,Takada Tadahiro²^ORCID,Strasberg Steven³,Isaji Shuji⁴^ORCID,Sano Keiji²^ORCID,Yoshida Masahiro⁵,Itoi Takao⁶,Okamoto Kohji⁷^ORCID,Kiriyama Seiki⁸,Yagi Shintaro⁹^ORCID,Matsubara Takashi¹⁰^ORCID,Higuchi Ryota¹¹^ORCID,Ohyama Tetsuji¹²,Misawa Takeyuki²,Mukai Shuntaro⁶^ORCID,Mori Yasuhisa¹³^ORCID,Asai Koji¹⁴^ORCID,Mizuno Shugo¹⁵^ORCID,Abe Yuta¹⁶,Suzuki Kenji¹⁷,Homma Yuki¹⁸^ORCID,Hata Jiro¹⁹^ORCID,Tsukiyama Kana²,Kumamoto Yusuke²⁰^ORCID,Tsuyuguchi Toshio²¹,Maruo Hirotoshi²²^ORCID,Asano Yukio¹^ORCID,Hori Shutaro¹⁶,Shibuya Makoto²,Mayumi Toshihiko²³,Toyota Naoyuki²⁴,Umezawa Akiko²⁵,Gomi Harumi²⁶^ORCID,Horiguchi Akihiko¹

Affiliation:

1. Department of Gastroenterological Surgery Fujita Health University Bantane Hospital Nagoya Japan

2. Department of Surgery Teikyo University School of Medicine Tokyo Japan

3. Section of Hepatobiliary‐Pancreatic and GI Surgery Washington University St. Louis Missouri USA

4. Matsusaka City Hospital Mie University Tsu Japan

5. Department of Hepato‐Biliary‐Pancreatic and Gastrointestinal Surgery, School of Medicine International University of Health and Welfare Ichikawa Japan

6. Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan

7. Department of Surgery, Center for Gastroenterology and Liver Surgery Kitakyushu City Yahata Hospital Kitakyushu Japan

8. Department of Gastroenterology Ogaki Municipal Hospital Ogaki Japan

9. Department of Hepato‐Biliary‐Pancreatic Surgery and Transplantation Kanazawa University Kanazawa Japan

10. Department of Radiology Kanazawa University Graduate School of Medical Sciences Kanazawa Japan

11. Department of Surgery, Institute of Gastroenterology Tokyo Women's Medical University Tokyo Japan

12. Biostatistics Center Kurume University Kurume Japan

13. Department of Surgery, School of Medicine University of Occupational and Environmental Health Kitakyushu Japan

14. Department of Surgery Toho University Ohashi Medical Center Tokyo Japan

15. Department of Hepato‐Biliary‐Pancreatic and Transplant Surgery Mie University Graduate School of Medicine Tsu Japan

16. Department of Surgery Keio University Tokyo Japan

17. Department of Surgery Fujinomiya City General Hospital Fujinomiya Japan

18. Department of Gastroenterological Surgery Yokohama City University, School of Medicine Yokohama Japan

19. Department of Clinical Pathology and Laboratory Medicine Kawasaki Medical School Kurashiki Japan

20. Department of General, Pediatric and Hepato‐Biliary‐Pancreatic Surgery Kitasato University Sagamihara Japan

21. Department of Gastroenterology Chiba Prefectural Sawara Hospital Katori Japan

22. Department of Surgery Shizuoka City Shimizu Hospital Shizuoka Japan

23. Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health Fukuoka Japan

24. Department of Surgery Tsudanuma Central General Hospital Narashino Japan

25. Department of Surgery, Minimally Invasive Surgery Center Yotsuya Medical Cube Tokyo Japan

26. International University of Health and Welfare, School of Medicine Narita Japan

Abstract

AbstractBackground/PurposeThe aim of this study was to clarify the clinical characteristics of acute cholangitis (AC) after bilioenteric anastomosis and stent‐related AC in a multi‐institutional retrospective study, and validate the TG18 diagnostic performance for various type of cholangitis.MethodsWe retrospectively reviewed 1079 AC patients during 2020, at 16 Tokyo Guidelines 18 (TG 18) Core Meeting institutions. Of these, the post‐biliary reconstruction associated AC (PBR‐AC), stent‐associated AC (S‐AC) and common AC (C‐AC) were 228, 307, and 544, respectively. The characteristics of each AC were compared, and the TG18 diagnostic performance of each was evaluated.ResultsThe PBR‐AC group showed significantly milder biliary stasis compared to the C‐AC group. Using TG18 criteria, definitive diagnosis rate in the PBR‐AC group was significantly lower than that in the C‐AC group (59.6% vs. 79.6%, p < .001) because of significantly lower prevalence of TG 18 imaging findings and milder bile stasis. In the S‐AC group, the bile stasis was also milder, but definitive‐diagnostic rate was significantly higher (95.1%) compared to the C‐AC group. The incidence of transient hepatic attenuation difference (THAD) and pneumobilia were more frequent in PBR‐AC than that in C‐AC. The definitive‐diagnostic rate of PBR‐AC (59.6%–78.1%) and total cohort (79.6%–85.3%) were significantly improved when newly adding these items to TG18 diagnostic imaging findings.ConclusionsThe diagnostic rate of PBR‐AC using TG18 is low, but adding THAD and pneumobilia to TG imaging criteria may improve TG diagnostic performance.

Publisher

Wiley

Subject

Hepatology,Surgery

Link

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jhbp.1368

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