Techniques of biliary drainage for acute cholangitis: Tokyo Guidelines.
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.
Tsuyuguchi
Toshio
T
Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
Takada
Tadahiro
T
Kawarada
Yoshifumi
Y
Nimura
Yuji
Y
Wada
Keita
K
Nagino
Masato
M
Mayumi
Toshihiko
T
Yoshida
Masahiro
M
Miura
Fumihiko
F
Tanaka
Atsushi
A
Yamashita
Yuichi
Y
Hirota
Masahiko
M
Hirata
Koichi
K
Yasuda
Hideki
H
Kimura
Yasutoshi
Y
Strasberg
Steven
S
Pitt
Henry
H
Büchler
Markus W
MW
Neuhaus
Horst
H
Belghiti
Jacques
J
de Santibanes
Eduardo
E
Fan
Sheung-Tat
ST
Liau
Kui-Hin
KH
Sachakul
Vibul
V
D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D006801:Humans; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D014041:Tokyo