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Evaluation of Tokyo Guidelines 2013 for diagnosis and severity assessment of acute cholangitis at Southern Odisha: A prospective study

Manas Ranjan Dash, Anupam Mishra, Sworupa Nanda Mallick, Amar Kumar Behera, Deba Prasad Rath, Rajinder Kumar Mishra.




Abstract
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Background: Acute cholangitis is a potentially life-threatening complication due to an increase in pressure of the common bile duct due to obstruction and subsequent bacterial infection and sepsis which results in high morbidity and mortality reaching up to 100%.So early diagnosis and management is a very important step to reduce morbidity and mortality. Acute cholangitis needs a clinical diagnosis taking into account the various sign and symptoms for which the TG 13 criteria were proposed for diagnosis, grading of severity and management.
Aims and Objectives: To evaluate the Tokyo guidelines 2013 on cases of acute cholangitis with regards to early diagnosis, grading of severity, early management and to compare its efficacy with Charcot’s Triad in M.K.C.G Medical College and Hospital, Berhampur, Odisha.
Materials and Methods:
In the present study, 51 patients, who presented to the OPD or emergency department of MKCG Medical College and hospital, Berhampur with features of fever and jaundice with or without pain abdomen during the study period from August 2018 to July 2020. All the patients who presented with fever and jaundice were evaluated according to TG 13 diagnostic and grading criteria. Biochemical and Radiological investigations were done according to TG 13 criteria.
Results:
According to TG 13 severity assessment guidelines, the highest number of patients were graded as grade I i.e. 20(46.51%) and the least number of patients was graded as grade III i.e.7(16.29%). In all the patients diagnosed with acute cholangitis to whom treatment was given according to management protocol of TG 13, 35 patients(81.39%) improved with either conservative or surgical management or with both and mortality was there in 8 patients(18.61%). CONCLUSION
On comparing, the sensitivity of Charcot’s triad and Tokyo guidelines 2013 was 54.54% and 87.5% respectively, clearly suggesting the higher efficacy of Tokyo guidelines 2013 in diagnosing Acute cholangitis (AC).

Key words: Cholangitis, Tokyo, Charcot’s






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