Methods and timing of biliary drainage for acute cholangitis: Tokyo Guidelines.
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.
Nagino
Masato
M
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Takada
Tadahiro
T
Kawarada
Yoshifumi
Y
Nimura
Yuji
Y
Yamashita
Yuichi
Y
Tsuyuguchi
Toshio
T
Wada
Keita
K
Mayumi
Toshihiko
T
Yoshida
Masahiro
M
Miura
Fumihiko
F
Strasberg
Steven M
SM
Pitt
Henry A
HA
Belghiti
Jacques
J
Fan
Sheung-Tat
ST
Liau
Kui-Hin
KH
Belli
Giulio
G
Chen
Xiao-Ping
XP
Lai
Edward Cheuck-Seen
EC
Philippi
Benny P
BP
Singh
Harjit
H
Supe
Avinash
A
D000208:Acute Disease; D002761:Cholangitis / Q000601:surgery*; D002763:Cholecystectomy; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D006801:Humans; D014041:Tokyo