Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

• Published in: Journal of hepato-biliary-pancreatic sciences 2018-01, Vol.25 (1), p.87-95
• Main Authors: Mori, Yasuhisa, Itoi, Takao, Baron, Todd H., Takada, Tadahiro, Strasberg, Steven M., Pitt, Henry A., Ukai, Tomohiko, Shikata, Satoru, Noguchi, Yoshinori, Teoh, Anthony Yuen Bun, Kim, Myung‐Hwan, Asbun, Horacio J., Endo, Itaru, Yokoe, Masamichi, Miura, Fumihiko, Okamoto, Kohji, Suzuki, Kenji, Umezawa, Akiko, Iwashita, Yukio, Hibi, Taizo, Wakabayashi, Go, Han, Ho‐Seong, Yoon, Yoo‐Seok, Choi, In‐Seok, Hwang, Tsann‐Long, Chen, Miin‐Fu, Garden, O. James, Singh, Harjit, Liau, Kui‐Hin, Huang, Wayne Shih‐Wei, Gouma, Dirk J., Belli, Giulio, Dervenis, Christos, Santibañes, Eduardo, Giménez, Mariano Eduardo, Windsor, John A., Lau, Wan Yee, Cherqui, Daniel, Jagannath, Palepu, Supe, Avinash Nivritti, Liu, Keng‐Hao, Su, Cheng‐Hsi, Deziel, Daniel J., Chen, Xiao‐Ping, Fan, Sheung Tat, Ker, Chen‐Guo, Jonas, Eduard, Padbury, Robert, Mukai, Shuntaro, Honda, Goro, Sugioka, Atsushi, Asai, Koji, Higuchi, Ryota, Wada, Keita, Yoshida, Masahiro, Mayumi, Toshihiko, Hirata, Koichi, Sumiyama, Yoshinobu, Inui, Kazuo, Yamamoto, Masakazu
• Format: Article
• Language: English
• Subjects: Acute cholecystitis; Endoscopic transpapillary gallbladder drainage; Endoscopic ultrasound‐guided gallbladder drainage; Endoscopy; Gallbladder; Gallbladder diseases; Gallbladder drainage; Medicin och hälsovetenskap; Percutaneous transhepatic gallbladder drainage; Ultrasonic imaging
• ISSN: 1868-6974; 1868-6982; 1868-6982
• DOI: 10.1002/jhbp.504

Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high‐risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high‐risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound‐guided gallbladder drainage can be considered in high‐volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso‐gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound‐guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included. Highlight The TG13 need to be refined based on newly published data. In the updated TG18, Mori and colleagues recommend percutaneous transhepatic gallbladder drainage as a standard drainage method and the first alternative to surgery in surgically high‐risk patients with acute cholecystitis. They further describe the latest alternative endoscopic drainage techniques.