Retrospective application and validation of Tokyo 18 guidelines for diagnosis and stratification of acute cholangitis in Qatar

Background: Acute cholangitis (AC) is a life-threatening condition with a mortality risk of 8%–10%. Despite no gold standard for diagnosis, Charcot's triad was introduced to diagnose AC. However, the triad had a low sensitivity (50%–70%). Recently, Tokyo guidelines (TG) for the diagnosis of AC gained international recognition for their excellent diagnostic rate. Objective: In this study, we aimed to apply TG18 guidelines in a retrospective manner to diagnose AC in Qatar to validate TG18. Methods: This retrospective observational study recruited 295 patients with clinically proven AC between January 2016 and July 2018. Results: Of the 213 patients, 72.2% were men. The mean age was 51.4 ± 17.5 years. The most common co-morbidity was hypertension (36.3%). Common bile duct stones were the most common cause of biliary obstruction found in 165 (55.9%) patients. The diagnostic rate of TG18 was 91.9% in contrast to Charcot's triad (34.9%). By TG18 grading, 150 (50.8%) patients were grade I. ERCP was done in 62% patients, and 52.5% of them were grade I. Conclusion: AC management in Qatar meets the international standards with a low mortality rate. TG18 guidelines had a high diagnostic rate among our patient population.