Abstract：
OBJECTIVE: The 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.
METHODS: We 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.
RESULTS: The 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.
CONCLUSIONS: The diagnostic rate of PBR-AC using TG18 is low, but adding THAD and pneumobilia to TG imaging criteria may improve TG diagnostic performance.
METHODS: We 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.
RESULTS: The 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.
CONCLUSIONS: The diagnostic rate of PBR-AC using TG18 is low, but adding THAD and pneumobilia to TG imaging criteria may improve TG diagnostic performance.
摘要：
目的：这项研究的目的是在一项多机构回顾性研究中阐明急性胆管炎（AC）的临床特征，并验证TG18对各种类型胆管炎的诊断性能。
方法：我们回顾性回顾了2020年在16个东京指南18（TG18）核心会议机构中的1079例AC患者。其中,胆道重建后相关AC（PBR-AC），支架相关AC（S-AC）和普通AC（C-AC）分别为228、307和544。比较了每种AC的特性，并评估了各自的TG18诊断性能。
结果：与C-AC组相比，PBR-AC组表现出明显温和的胆汁淤滞。使用TG18标准，PBR-AC组确诊率明显低于C-AC组(59.6%vs.79.6%,p<.001），因为TG18影像学发现的患病率显着降低，胆汁淤滞较轻。在S-AC组中,胆汁淤积也较温和，但明确诊断率明显高于C-AC组(95.1%).PBR-AC与C-AC相比，短暂的肝衰减差异（THAD）和血栓形成的发生率更高。当将这些项目新添加到TG18诊断影像学发现中时，PBR-AC的最终诊断率（59.6％-78.1％）和总队列（79.6％-85.3％）显着提高。
结论：使用TG18对PBR-AC的诊断率较低，但在TG成像标准中加入THAD和pneumobilia可能会提高TG诊断性能.
方法：我们回顾性回顾了2020年在16个东京指南18（TG18）核心会议机构中的1079例AC患者。其中,胆道重建后相关AC（PBR-AC），支架相关AC（S-AC）和普通AC（C-AC）分别为228、307和544。比较了每种AC的特性，并评估了各自的TG18诊断性能。
结果：与C-AC组相比，PBR-AC组表现出明显温和的胆汁淤滞。使用TG18标准，PBR-AC组确诊率明显低于C-AC组(59.6%vs.79.6%,p<.001），因为TG18影像学发现的患病率显着降低，胆汁淤滞较轻。在S-AC组中,胆汁淤积也较温和，但明确诊断率明显高于C-AC组(95.1%).PBR-AC与C-AC相比，短暂的肝衰减差异（THAD）和血栓形成的发生率更高。当将这些项目新添加到TG18诊断影像学发现中时，PBR-AC的最终诊断率（59.6％-78.1％）和总队列（79.6％-85.3％）显着提高。
结论：使用TG18对PBR-AC的诊断率较低，但在TG成像标准中加入THAD和pneumobilia可能会提高TG诊断性能.
