Optimal drainage method for acute cholangitis according to updated TG18 and latest treads

Abstract

Early drainage is required for moderate or severe acute cholangitis, and the first choice of biliary drainage is endoscopic transpapillary drainage. If difficult, percutaneous transhepatic biliary drainage or endosonography–guided biliary drainage is used as a useful alternative drainage technique. In the treatment of bile duct stone, stone removal at a single session may be considered in patients with mild or moderate acute cholangitis according to Tokyo Guidelines 2018. However, if patients have coagulopathy or take anticoagulant therapy, stone removal at a second session is recommended. Balloon enteroscopy–assisted endoscopic retrograde cholangiopancreatography is recommended in patients with surgically altered anatomy, but the technical success rate is not always high. With the diversification of drainage procedures, the technical difference between facilities is increasing, and it is necessary to respond flexibly according to the situation of the facilities and the cases.