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Relationship between the Tokyo Guidelines and Pathological Severity in Acute Cholecystitis
Tae Young Park1, Jae Hyuk Do2, Hyoung-Chul Oh2
1Division of Gastroenterology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong 14353, Republic of Korea.
Journal of Personalized Medicine
|September 28, 2023
Summary
The severity of acute cholecystitis (AC) grading by Tokyo Guidelines does not correlate with gallbladder inflammation. However, higher AC grades show increased positive microbiological cultures in blood and bile.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Infectious Disease
Background:
- Acute cholecystitis (AC) severity is classified using Tokyo Guidelines (TGs).
- The correlation between AC severity, gallbladder (GB) inflammation extent, and laboratory findings remains unclear.
- This study investigates the relationship between AC severity (TGs), GB histopathology, and laboratory/microbiological data.
Purpose of the Study:
- To evaluate if AC severity, per Tokyo Guidelines, aligns with histopathological GB inflammation.
- To assess the correlation between AC severity and laboratory findings, including blood and bile microbiological cultures.
- To determine the utility of TGs in reflecting the true extent of inflammation and infection in AC.
Main Methods:
- Retrospective review of 217 patients who underwent cholecystectomy for AC (Jan 2017 - May 2020).
- Comparison of demographic data, laboratory results, microbiological cultures (blood/bile), GB inflammation extent, and stone composition based on TG severity grades (I, II, III).
- Statistical analysis to identify significant differences between severity groups.
Main Results:
- No significant difference in the extent of gallbladder inflammation was observed across TG severity grades.
- Higher AC severity grades (III vs. I/II) were associated with older patients and significant alterations in laboratory markers (WBC, CRP, creatinine, bilirubin, platelets, albumin).
- Microbiological isolation rates in both blood and bile increased significantly with higher AC severity grades (p < 0.001).
Conclusions:
- Tokyo Guideline-based AC severity does not correlate with histopathological gallbladder inflammation.
- Increased microbiological isolation in blood and bile is proportionally associated with higher AC severity grades.
- Laboratory findings and microbiological data, rather than histopathological inflammation extent, appear more reflective of AC severity as defined by TGs.
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