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Endoscopic management of acute cholangitis according to the TG 13
Author(s) -
Tsuchiya Takayoshi,
Sofuni Atsushi,
Tsuji Shujiro,
Mukai Shuntaro,
Matsunami Yukitoshi,
Nagakawa Yuichi,
Itoi Takao
Publication year - 2017
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12799
Subject(s) - medicine , general surgery , gastroenterology
The Tokyo Guidelines 2013 (TG13) recommend that endoscopic drainage should be the first‐choice treatment for biliary decompression in patients with acute cholangitis. Timing of biliary drainage for acute cholangitis should be based on the severity of the disease. For patients with severe acute cholangitis, appropriate organ support and urgent biliary drainage are needed. For patients with moderate acute cholangitis, early biliary drainage is needed. For patients with mild acute cholangitis, biliary drainage is needed when initial treatment such as antimicrobial therapy is ineffective. There are three methods of biliary drainage: endoscopic drainage, percutaneous transhepatic drainage, and surgical drainage. Endoscopic drainage is less invasive than the other two drainage methods. The drainage method (endoscopic nasobiliary drainage and stenting) depends on the endoscopist's preference but endoscopic sphincterotomy should be selected rather than endoscopic papillary balloon dilation from the aspect of procedure‐related complications. In the TG 13, balloon enteroscopy‐assisted and endoscopic ultrasound‐guided biliary drainages have been newly added as specific drainage methods. Recent studies have demonstrated their usefulness and safety. These drainage methods will become more widespread in the future.