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: no Grade II or III criteria at diagnosis.
→ Antibiotics; biliary drainage if there is no response to initial treatment within 24 hours; treat the cause (e.g. ERCP for stones) once settled.
Grade II: two or more of the Grade II factors, without organ dysfunction.
→ Antibiotics and early biliary drainage (endoscopic or percutaneous); close monitoring.
Grade III: organ dysfunction present (cardiovascular, renal, respiratory, hepatic, haematological, neurological)
→ Organ support (ICU/HDU) and antibiotics, with urgent biliary drainage once stabilised; multidisciplinary care.
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.