Re: Acute calculus cholecystitis: commentary on Tokyo Guidelines 2018

Re: Acute calculus cholecystitis: commentary on Tokyo Guidelines 2018 Dear Editor,We thank Pisano and Campanile for their comments on our recent papers . The intention underlying Tokyo Guidelines 18 (TG18) is to provide recommendations for the optimal care of patients with acute cholangitis and cholecystitis based on a systematic review of the existing evidence, including the results of validation studies of TG13 and a Japan–Taiwan collaboration study that included over 11,000 patients.In response to the first comment, Yokoe et al. included one main analysis and three sub‐analyses. The main analysis was of the relationship between severity grade and 30‐day mortality in 680 cases. One of the sub‐analyses was of the relationship between severity and cholecystectomy type regardless of 30‐day mortality in 511 cases. Importantly, the cases for these analyses were sampled independently from the cohort of grade III cases (n = 768). Therefore, the “25% (169 out of 680)” of cases Pisano and Campanile note as being missing from the analyses is an incorrect interpretation of the study methods.In response to the second comment regarding Endo et al. , note that this was a retrospective, observational study of a heterogeneous cohort of patients with grade III acute cholecystitis, and that one of the study groups included both patients too sick for surgery http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Hepato-Biliary-Pancreatic Sciences Wiley

Re: Acute calculus cholecystitis: commentary on Tokyo Guidelines 2018

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Publisher
Wiley
Copyright
Copyright © 2018 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery
ISSN
1868-6974
eISSN
1868-6982
D.O.I.
10.1002/jhbp.539
Publisher site
See Article on Publisher Site

Abstract

Dear Editor,We thank Pisano and Campanile for their comments on our recent papers . The intention underlying Tokyo Guidelines 18 (TG18) is to provide recommendations for the optimal care of patients with acute cholangitis and cholecystitis based on a systematic review of the existing evidence, including the results of validation studies of TG13 and a Japan–Taiwan collaboration study that included over 11,000 patients.In response to the first comment, Yokoe et al. included one main analysis and three sub‐analyses. The main analysis was of the relationship between severity grade and 30‐day mortality in 680 cases. One of the sub‐analyses was of the relationship between severity and cholecystectomy type regardless of 30‐day mortality in 511 cases. Importantly, the cases for these analyses were sampled independently from the cohort of grade III cases (n = 768). Therefore, the “25% (169 out of 680)” of cases Pisano and Campanile note as being missing from the analyses is an incorrect interpretation of the study methods.In response to the second comment regarding Endo et al. , note that this was a retrospective, observational study of a heterogeneous cohort of patients with grade III acute cholecystitis, and that one of the study groups included both patients too sick for surgery

Journal

Journal of Hepato-Biliary-Pancreatic SciencesWiley

Published: Jan 1, 2018

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