title: Controversy and progress for treatment of acute cholangitis after Tokyo Guidelines (TG13).
abstract: Tokyo Guideline 2013 (TG13) is an international guideline for the diagnosis, classification and treatment of acute cholangitis. Progress and controversy for the two years after TG13 was summarized. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are both effective imaging tests for common bile duct (CBD) stones. More factors e.g. obesity may be involved in severity assessment. Initiation of broad-spectrum antibiotics addressing the typical Gram-negative enteric bacteria spectrum and early biliary drainage are the mainstay therapeutic options. Early laparoscopic exploration is also an option for stone-related nonsevere acute cholangitis besides endoscopic retrograde cholangial or percutaneous transhepatic cholangial drainage. Surgical biliary drainage should be avoided in severe cholangitis.
authors.affiliation: General Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University).
authors.forename: Zhipeng
authors.initials: Z
authors.lastname: Sun
authors.forename: Yubing
authors.initials: Y
authors.lastname: Zhu
authors.forename: Bin
authors.initials: B
authors.lastname: Zhu
authors.forename: Guangzhong
authors.initials: G
authors.lastname: Xu
authors.forename: Nengwei
authors.initials: N
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D014041:Tokyo