Ann Geriatr Med Res 2016; 20(4): 177-184
Association Between Extrahepatic Duct Diameter on Abdominal Computed Tomography and Severity Classified Using Tokyo Guidelines 2013 in Elderly Patients With Cholangitis
Hyeon Song Kim1,2, Chang Min Lee1,2, Byuk Sung Ko1, Sung Hyuk Park1,2, Woong Jung1,2, Myung Chun Kim1,2, Young Gwan Ko2
1Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, 2Department of Emergency Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
Correspondence to: Chang Min Lee, MD 
Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea 
Tel: +82-2-440-6176 
Received: September 8, 2016; Revised: October 21, 2016; Accepted: October 26, 2016; Published online: December 31, 2016.
© The Korea Geriatrics Society. All rights reserved.

Background: It is important to estimate the severity of early stage cholangitis in elderly patients to determine the most appropriate timing of biliary decompression. Abdominal computed tomography (CT) is the modality of choice for the diagnosis of cholangitis; however, studies evaluating the correlation between cholangitis severity and CT findings, specifically extrahepatic duct (EHD) diameter, are insufficient. Therefore, this study aimed to evaluate the relationship between EHD diameter and disease severity in elderly patients with cholangitis. 
Methods: A total of 155 patients over the age of 65 years, admitted to the Emergency Department, with a diagnosis of cholangitis from January 2010 to December 2015 were retrospectively analyzed. Using the Tokyo Guidelines 2013, patients were grouped into mild and moderate to severe cholangitis groups. We then analyzed the patient’s medical backgrounds, vital signs, and CT findings. To evaluate the significance of the CT findings in relation to cholangitis severity, a univariate analysis was performed within each group, using the collected variables. A multiple logistic regression analysis was performed using the variables with p<0.05. 
Results: On univariate analysis, EHD diameter (p<0.001) and combined cholecystitis (p=0.009) were found to be significant CT findings; EHD diameter (odds ratio [OR], 1.235; 95% confidence interval [CI], 1.115-1.368; p<0.001) and combined cholecystitis (OR, 2.666; 95% CI, 1.145-6.212; p=0.023) were also statistically significant after multiple logistic regression. 
Conclusion: In conclusion, increased EHD diameter was associated with disease severity in elderly patients with cholangitis. EHD diameter is easy to measure on CT and can be helpful in establishing an appropriate treatment plan.
Keywords: Cholangitis, Computed tomography, Geriatrics, Severity, Bile ducts

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