Abstract
BackgroundAcute cholangitis is an infection requiring endoscopic retrograde cholangiopancreatography (ERCP) and antibiotics. Several diagnostic tools help to diagnose cholangitis. Because diagnostic performance of these tools has not been studied and might therefore impose unnecessary ERCPs, we aimed to evaluate this.MethodsWe established a nationwide prospective cohort of patients with suspected biliary obstruction who underwent an ERCP. We assessed the diagnostic performance of Tokyo Guidelines (TG18), Dutch Pancreatitis Study Group (DPSG) criteria, and Charcot triad relative to real‐world cholangitis as the reference standard.Results127 (16%) of 794 patients were diagnosed with real‐world cholangitis. Using the TG18, DPSG, and Charcot triad, 345 (44%), 55 (7%), and 66 (8%) patients were defined as having cholangitis, respectively. Sensitivity for TG18 was 82% (95% CI 74‐88) and specificity 60% (95% CI 56‐63). The sensitivity for DPSG and Charcot was 42% (95% CI 33‐51) and 46% (95% CI 38‐56), specificity was 99.7% (95% CI 99‐100) and 99% (95% CI 98‐100), respectively.ConclusionsTG18 criteria incorrectly diagnoses four out of ten patients with real‐world cholangitis, while DPSG and Charcot criteria failed to diagnose more than half of patients. As the cholangitis diagnosis has many consequences for treatment, there is a need for more accurate diagnostic tools or work‐up towards ERCP.
Highlights
Acute or ascending cholangitis is a bacterial infection of the biliary tract superimposed upon bile duct obstruction.[1,2] The most common cause is biliary obstruction as a result of common bile duct (CBD) stones.[2]
We aimed to evaluate the diagnostic performance of Tokyo Guidelines 2018 (TG18), Dutch Pancreatitis Study Group (DPSG) criteria, and the Charcot triad for diagnosing acute cholangitis in patients with biliary obstruction, using real-world diagnosis as the reference standard
We found that four out of ten patients would be incorrectly diagnosed with acute cholangitis by applying the TG18
Summary
Acute or ascending cholangitis is a bacterial infection of the biliary tract superimposed upon bile duct obstruction.[1,2] The most common cause is biliary obstruction as a result of common bile duct (CBD) stones.[2]. Acute cholangitis is an infection requiring endoscopic retrograde cholangiopancreatography (ERCP) and antibiotics. We assessed the diagnostic performance of Tokyo Guidelines (TG18), Dutch Pancreatitis Study Group (DPSG) criteria, and Charcot triad relative to real-world cholangitis as the reference standard. Results: 127 (16%) of 794 patients were diagnosed with real-w orld cholangitis. Using the TG18, DPSG, and Charcot triad, 345 (44%), 55 (7%), and 66 (8%) patients were defined as having cholangitis, respectively.
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