Tokyo Guidelines 2018 — Acute Cholangitis Severity
Tokyo Guidelines 2018 (TG18) for grading severity of acute cholangitis to guide management decisions including timing of biliary drainage.
Score interpretation
Grade I: acute cholangitis without Grade II/III features
→ IV antibiotics; biliary drainage semi-elective (within 24–48h); oral antibiotics after improvement
Grade II: not responsive to initial medical treatment or has specified features (high WBC, fever >39°C, age >75, bilirubin ≥85 μmol/L, hypoalbuminaemia)
→ Urgent biliary drainage (ERCP within 24h); IV broad-spectrum antibiotics; close monitoring
Grade III: organ dysfunction present (cardiovascular, renal, respiratory, hepatic, haematological, neurological)
→ Emergency biliary drainage; ICU admission; aggressive resuscitation; multidisciplinary team involvement
Interpretation bands for the TG18 Cholangitis. Apply clinical judgement and local guidance.
References
- Kiriyama S et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;25(1):17–30.
Related
Curated clinical cross-links plus same-class fallbacks.
- Obeticholic Acid · FXR Agonist (Primary Biliary Cholangitis)
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- Prednisolone (Systemic) · Systemic Corticosteroid — Acute Dermatoses
- Methoxyflurane · Inhaled Analgesic — Acute Pain
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.