Tokyo Guidelines (TG18) for Acute Cholangitis Provide Improved Specificity and Accuracy Compared to Fellow Assessment

Area of Science:

• Gastroenterology
• Hepatology
• Clinical Diagnostics

Background:

• Acute cholangitis (AC) poses a significant mortality risk if not promptly treated.
• The 2018 Tokyo Guidelines (TG18) are the global standard for AC management, requiring clinical validation.
• Current diagnostic accuracy and early detection of AC need improvement.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the 2018 Tokyo Guidelines (TG18) for acute cholangitis (AC).
• To compare the diagnostic performance of TG18 criteria against fellow clinical assessment.
• To assess the impact of TG18 on early detection and management of AC.

Main Methods:

• Retrospective review of 206 patients diagnosed with cholangitis (ICD-9/ICD-10 codes).
• Inclusion of 91 patients with gastroenterology inpatient consult fellow evaluation and clinical AC diagnosis.
• Comparison of TG18 scoring against definitive diagnosis post-endoscopic retrograde cholangiopancreatography (ERCP) and fellow assessments.

Main Results:

• TG18 criteria demonstrated 81% accuracy, with 86% sensitivity and 63% specificity for AC post-ERCP (p <0.05).
• Fellow clinical suspicion showed 71% accuracy, with 90.3% sensitivity but 0% specificity.
• No significant difference in fellow diagnostic accuracy was observed based on training year.

Conclusions:

• The 2018 Tokyo Guidelines (TG18) enhance diagnostic accuracy for acute cholangitis (AC).
• Application of TG18 criteria effectively reduces false positive diagnoses and unnecessary ERCPs.
• Improved diagnostic accuracy leads to decreased healthcare costs and avoids complications associated with unwarranted procedures.