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