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INTRODUCTION

This is a perspective on biliary diseases to complement the excellent chapters on biliary tract disease in this text. It focuses on areas in my experience that I believe deserve emphasis.

TOKYO GUIDELINES FOR ACUTE CHOLECYSTITIS AND ACUTE CHOLANGITIS

The Tokyo Guidelines (TG) provide evidence based criteria for the diagnosis and severity grading of acute cholecystitis and acute cholangitis. First published in 2007, there have been two revisions, the latest just published in 2018 (TG18). The guidelines are available in an app for smartphones, and the app is very useful in the ER and on the ward. Furthermore, standardization of criteria for diagnosis and severity grading provide a stable platform for performance of comparative outcome studies.1,2 Tables 67-1, 67-2, 67-3, 67-4 are Tokyo guidelines 2018 diagnostic criteria and severity grading for acute cholangitis and acute cholecystitis respectively.

TABLE 67-1TOKYO GUIDELINES 2018 DIAGNOSTIC CRITERIA FOR ACUTE CHOLECYSTITIS
TABLE 67-2TOKYO GUIDELINES 2018 SEVERITY GRADING FOR ACUTE CHOLECYSTITIS

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