Tokyo Guidelines 2018 — Acute Cholecystitis Severity
Tokyo Guidelines 2018 (TG18) for grading severity of acute cholecystitis to guide timing of cholecystectomy.
Score interpretation
Grade I: no Grade II or III features.
→ Early laparoscopic cholecystectomy (within 72h); IV antibiotics; low risk
Grade II: marked local inflammation — WBC >18, palpable mass, prolonged symptoms or marked local peritonitis
→ Early cholecystectomy by experienced surgeon, or percutaneous cholecystostomy if unfit; IV antibiotics
Grade III: organ dysfunction present — high risk of morbidity and mortality
→ Urgent ICU care; IV antibiotics; percutaneous cholecystostomy as bridge; cholecystectomy after stabilisation
Interpretation bands for the TG18 Cholecystitis. Apply clinical judgement and local guidance.
References
- Yokoe M et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):41–54.
Related
Curated clinical cross-links plus same-class fallbacks.
- 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
- Colchicine (Acute Gout) · Anti-Inflammatory (Microtubule Inhibitor)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.