title: TG13 indications and techniques for biliary drainage in acute cholangitis (with videos).
abstract: The Tokyo Guidelines of 2007 (TG07) described the techniques and recommendations of biliary decompression in patients with acute cholangitis. TG07 recommended that endoscopic transpapillary biliary drainage should be selected as a first-choice therapy for acute cholangitis because it is associated with a low mortality rate and shorter duration of hospitalization. However, TG07 did not include the whole technique of standard endoscopic transpapillary biliary drainage, for example, biliary cannulation techniques including contrast medium-assisted cannulation, wire-guided cannulation, and treatment of duodenal major papilla using endoscopic papillary balloon dilation (EPBD). Furthermore, recently single- or double-balloon enteroscopy-assisted biliary drainage (BE-BD) and endoscopic ultrasonography-guided biliary drainage (EUS-BD) have been reported as special techniques for biliary drainage. Nevertheless, the updated Tokyo Guidelines (TG13) recommends that endoscopic drainage should be first-choice treatment for biliary decompression in patients with non-surgically altered anatomy and suggests that the choice of cannulation technique or drainage method (endoscopic naso-biliary drainage and stenting) depends on the endoscopist's preference but EST should be selected rather than EPBD from the aspect of procedure-related complications. In terms of BE-BD and EUS-BD, although there are many reports on the their usefulness, they should be performed by skilled endoscopists in high-volume institutes, who are good at enteroscopy or echoendosonography, respectively, because procedures and devices are not yet established. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. itoi@tokyo-med.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
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: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
authors.forename: Palepu
authors.initials: P
authors.lastname: Jagannath
authors.forename: Harumi
authors.initials: H
authors.lastname: Gomi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kimura
authors.forename: Ryota
authors.initials: R
authors.lastname: Higuchi
mesh_terms: D000208:Acute Disease; D002761:Cholangitis / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D006801:Humans