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Techniques of biliary drainage for acute cholangitis: Tokyo Guidelines
Author(s) -
Tsuyuguchi Toshio,
Takada Tadahiro,
Kawarada Yoshifumi,
Nimura Yuji,
Wada Keita,
Nagino Masato,
Mayumi Toshihiko,
Yoshida Masahiro,
Miura Fumihiko,
Tanaka Atsushi,
Yamashita Yuichi,
Hirota Masahiko,
Hirata Koichi,
Yasuda Hideki,
Kimura Yasutoshi,
Strasberg Steven,
Pitt Henry,
Büchler Markus W.,
Neuhaus Horst,
Belghiti Jacques,
Santibanes Eduardo,
Fan SheungTat,
Liau KuiHin,
Sachakul Vibul
Publication year - 2007
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-006-1154-9
Subject(s) - medicine , drainage , percutaneous , acute pancreatitis , biliary drainage , surgery , decompression , endoscopy , complication , stent , randomized controlled trial , ecology , biology
Biliary decompression and drainage done in a timely manner is the cornerstone of acute cholangitis treatment. The mortality rate of acute cholangitis was extremely high when no interventional procedures, other than open drainage, were available. At present, endoscopic drainage is the procedure of first choice, in view of its safety and effectiveness. In patients with severe (grade III) disease, defined according to the severity assessment criteria in the Guidelines, biliary drainage should be done promptly with respiration management, while patients with moderate (grade II) disease also need to undergo drainage promptly with close monitoring of their responses to the primary care. For endoscopic drainage, endoscopic nasobiliary drainage (ENBD) or stent placement procedures are performed. Randomized controlled trials (RCTs) have reported no difference in the drainage effect of these two procedures, but case‐series studies have indicated the frequent occurrence of hemorrhage associated with endoscopic sphincterotomy (EST), and complications such as pancreatitis. Although the usefulness of percutaneous transhepatic drainage is supported by the case‐series studies, its lower success rate and higher complication rates makes it a second‐option procedure.