Endoscopic management of acute cholangitis as a result of common bile duct stones

Abstract

Acute cholangitis is infectious disease of the biliary system and potentially can cause significant morbidity and mortality. With advances in intensive care, antibiotic therapy advances and endoscopic and other modalities of biliary drainage, mortality rates have significantly come down of late. Although most cases respond to antibiotics alone, definitive therapy is required later in most of the patients. Increased biliary pressure leads to biliovenous reflux of bacteria and purulent bile into the circulation leading to systemic inflammation and sepsis with subsequent organ dysfunction. Biliary decompression increases antibiotic penetration in bile. Therefore, patients with high‐risk factors and organ dysfunction require early and urgent biliary drainage, respectively, as they are unlikely to respond with antibiotics alone. Biliary decompression is best achieved by endoscopic retrograde cholangiopancreatography (ERCP) compared to percutaneous and surgical decompression. ERCP can be technically difficult and sometimes unsuccessful especially in patients with altered anatomy and upper gastrointestinal obstruction. Earlier percutaneous transhepatic biliary drainage (PTBD) and surgery were the only viable options in those patients. PTBD requires a dilated biliary system, is more invasive and cannot achieve ductal clearance in cholangitis as a result of choledocholithiasis, whereas surgery is associated with high morbidity and mortality. Advances in therapeutic endoscopy such as balloon enteroscopy‐guided biliary drainage or endoscopic ultrasound guided‐biliary drainage have added new dimensions to endoscopic management of acute cholangitis as a result of choledocholithiasis obviating the need for more invasive procedures.

Risk Factors for Post-Endoscopic Retrograde Pancreatography Pancreatitis: A Retrospective Chart Review in a Regional Hospital in Japan

“…Endoscopic retrograde pancreatography (ERCP) plays an important role in the diagnosis and treatment of pancreatic and biliary system disorders [1][2][3][4]. Post-ERCP pancreatitis (PEP) is one of the most serious complications of ERCP.…”

Single-Stage Endoscopic Stone Extraction and Cholecystectomy during the Same Hospitalization

“…We usually perform biliary cannulation using a pull-type sphincterotome, which can control the angle for cannulation as well as enable a sphincterotomy [8]. Endoscopic sphincterotomy provides spontaneous duct drainage and allows small stones to pass spontaneously.…”

Routine guidewire application facilitates cholangioscopy in the management of postoperative residual hepatolithiasis

“…Based on this need, our center has improved the cholangioscopic procedure by using a wire to guide regular manipulation in patients with CLT or CJT. This wire‐guided procedure has previously been used during endoscopic retrograde cholangiopancreatography (ERCP) wherein a wire is routinely inserted and placed through duodenal papilla as further guidance of the accessories . It has also been used in the management of stenosis in cholangioscopy wherein an uninflated balloon should be inserted along a wire for dilatation .…”