title: Methods and timing of biliary drainage for acute cholangitis: Tokyo Guidelines.
abstract: Biliary drainage is a radical method to relieve cholestasis, a cause of acute cholangitis, and takes a central part in the treatment of acute cholangitis. Emergent drainage is essential for severe cases, whereas patients with moderate and mild disease should also receive drainage as soon as possible if they do not respond to conservative treatment, and their condition has not improved. Biliary drainage can be achieved via three different routes/procedures: endoscopic, percutaneous transhepatic, and open methods. The clinical value of both endoscopic and percutaneous transhepatic drainage is well known. Endoscopic drainage is associated with a low morbidity rate and shorter duration of hospitalization; therefore, this approach is advocated whenever it is applicable. In endoscopic drainage, either endoscopic nasobiliary drainage (ENBD) or tube stent placement can be used. There is no significant difference in the success rate, effectiveness, and morbidity between the two procedures. The decision to perform endoscopic sphincterotomy (EST) is made based on the patient's condition and the number and diameter of common bile duct stones. Open drainage, on the other hand, should be applied only in patients for whom endoscopic or percutaneous transhepatic drainage is contraindicated or has not been successfully performed. Cholecystectomy is recommended in patients with gallbladder stones, following the resolution of acute cholangitis with medical treatment, unless the patient has poor operative risk factors or declines surgery.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawarada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Kui-Hin
authors.initials: KH
authors.lastname: Liau
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Chen
authors.forename: Edward Cheuck-Seen
authors.initials: EC
authors.lastname: Lai
authors.forename: Benny P
authors.initials: BP
authors.lastname: Philippi
authors.forename: Harjit
authors.initials: H
authors.lastname: Singh
authors.forename: Avinash
authors.initials: A
authors.lastname: Supe
mesh_terms: D000208:Acute Disease; D002761:Cholangitis / Q000601:surgery*; D002763:Cholecystectomy; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D006801:Humans; D014041:Tokyo