Results of the Tokyo Consensus Meeting Tokyo Guidelines
Toshihiko Mayumi1, Tadahiro Takada2, Yoshifumi Kawarada3, Yuji Nimura4, Masahiro Yoshida2, Miho Sekimoto5, Fumihiko Miura2, Keita Wada2, Masahiko Hirota6, Yuichi Yamashita7, Masato Nagino4, Toshio Tsuyuguchi8, Atsushi Tanaka9, Harumi Gomi10, and Henry A. Pitt11Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan 2 Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan 3 Mie University School of Medicine, Mie, Japan 4 Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan 5Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan 6 Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan 7 Department of Surgery, Fukuoka University Hospital, Fukuoka, Japan 8 Department of Medicine and Clinical Oncology, Graduate School of MedicineChiba University, Chiba, Japan 9 Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan 10 Division of Infection Control and Prevention, Jichi Medical University Hospital, Tochigi, Japan 11 Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
Abstract A systematic review of references conducted in the process of developing the Guidelines for theManagement of Acute Cholangitis and Cholecystitis did not ﬁnd many high-quality research reports. There were no criteria for diagnosis, severity assessment, or patient transfer, and no established principles of clinical practice guidelines for acute cholangitis and cholecystitis. In order to develop guidelines that would be useful in clinical practice, an understanding of the current status ofclinical practice for acute cholangitis and cholecystitis was considered essential. After several open symposia and a survey of these two diseases, we developed and published a Japanese-language version of Evidence-Based Practice Guidelines for the Management of Acute Cholangitis and Cholecystitis. In order to prepare international Guidelines, we had repeated discussions about the draft Guidelinestogether with international experts, and, following the Consensus Meeting, held on April 1–2, 2006, in Tokyo, with the attendance of 300 world experts in the ﬁeld, the International Guidelines for the Management of Acute Cholangitis and Cholecystitis were developed. In this article, we outline the comments and opinions given at the International Meeting and how they are reﬂected in the ﬁnal versionof the Guidelines. Key words Guidelines · Consensus development meeting · Evidence-based medicine · Cholangitis · Acute cholecystitis
Introduction Guidelines should not only be based on evidence but should also meet the needs of current medical practice. We thought that adequate discussion, to receive feedOffprint requests to: T. Mayumi Received: May 31, 2006 / Accepted: August 6, 2006
backat open symposia and conferences, was essential during the development of the Guidelines. As one of the Integrated Research Projects for Assessing Medical Technology, sponsored by the Japanese Ministry of Health, Labour, and Welfare, a Research Group for the Preparation and Diffusion of Guidelines for the Management of Acute Biliary Tract Infection was established. With support from the JapaneseSociety for Abdominal Emergency Medicine, the Japan Biliary Association, and the Japanese Society of HepatoBiliary-Pancreatic Surgery, development of the Guidelines for the Management of Acute Cholangitis and Cholecystitis has been underway since 2003. After several open consensus conferences and open symposia to obtain feedback from members of these societies, a Japanese-language version of...