We read with interest the papers by Yokoe et al. and Okamoto et al. .In the first paper, the preservation of the original TG severity score, as the basis for TG18, is supported by the study of Yokoe et al. ; however, in our opinion, the scientific power is insufficient to draw a robust conclusion because the authors did not report therapeutic and outcome information for the 25% (169 out of 680) of Grade III patients; at the opposite end, the mortality rate was available for the 75% (511 out of 680) who received primary surgery, omitting the fact that in Grade III, TG13 suggests gallbladder drainage.Similarly, we elaborated some concerns in reading the study of Endo et al. , which supports the “Tokyo Guidelines 2018 Flowchart” : the treatment ranged from primary cholecystectomy, gallbladder drainage and cholecystectomy, gallbladder drainage alone, and antibiotic therapy alone. In particular, in Table 1, Endo et al. compared survivors and non‐survivors on Grade III according to the treatment options. In Grade III, the gallbladder drainage alone outcome is significantly worse than surgery (P = 0.0007; 156/21 vs. 387/16), worse than gallbladder drainage plus surgery (P < 0.0001; 156/21 vs. 253/2), and to antibiotic treatment
Journal of Hepato-Biliary-Pancreatic Sciences – Wiley
Published: Jan 1, 2018
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