2016 Volume 36 Issue 5 Pages 863-868
Our hospital guidelines for the treatment of acute cholangitis (AC) are based on the Updated Tokyo Guidelines. We carry out emergency drainage for patients classified as having severe AC, drainage within 24 hours for patients classified as having moderate AC, and undertake conservative treatment for patients classified as having mild AC. If a case of mild AC is upgraded in severity at the time of the reevaluation, we perform drainage. We retrospectively analyzed the data of 145 patients who were diagnosed as having AC from April 2013 to August 2015, to evaluate the validity of our hospital guidelines for the treatment of AC during this period. The severity distribution of AC in our study patients was as follows：severe in 9.0%, moderately severe in 46.9%, and mild in 44.1%. The success rates of endoscopic biliary drainage in the severe and moderately severe AC cases were 92.3% and 100%, respectively. In one case of severe AC in which drainage by endoscopic retrograde cholangiopancreatography proved difficult, the drainage was accomplished by percutaneous transhepatic cholangio drainage. The average times to drainage in the patients with severe and moderate AC were 3.4 hours and 10.6 hours, respectively. The AC severity was upgraded to moderately severe at the time of the reevaluation in 10.9%(7/67) of cases initially classified as having mild AC, however, in all of these cases, endoscopic biliary drainage was accomplished and was associated with improvement. There were no cases of death attributable to worsening of the severity of AC. We concluded that the timings for biliary drainage in AC cases of varying severities specified in our hospital? guidelines are appropriate.
