Treatment Of Acute Cholangitis Research Articles

A retrospective comparison of endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in the treatment of acute cholangitis

Endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) can rapidly alleviate obstruction, facilitate bile drainage, and reduce pressure in the bile duct. In this study, to evaluate the effect of plastic biliary stent on the recurrence rate of choledocholithiasis in patients with actual cholangitis after endoscopic retrograde cholangioangiography (ERCP), we a comparative analysis of the efficacy and safety between ENBD and ERBD in inflammatory remission rate, complication rate, and success rate of secondary or multiple endoscopic lithotomy. A total of 347 patients undergoing ENBD and ERBD were enrolled in this retrospective study. Preoperative assessments including blood tests, electrocardiography, abdominal ultrasonography, CT scans, MRI, or MRCP were conducted on all participants. Additionally, serum CRP and amylase levels were measured using a magnetic nanobead-based immunoassay. We found that The success rate of stone removal in the ENBD group was higher than that in the ERBD group (90.8% vs. 72.7%) (P <0.0001). The remission rate of inflammation in the ERBD group (100.0%) was higher than that in the ENBD group (98.7%) (P >0.05). No significant difference was observed between the ERBD group and the ENBD group in preoperative and postoperative inflammatory indexes (total bilirubin, direct bilirubin, white blood cells, neutrophils, CRP, and serum amylase). Moreover, there were significant differences in post-ERCP pancreatitis between the ERBD group and ENBD group. These results suggest that both ENBD and ERBD can effectively improve clinical efficacy. Moreover, magnetic nanobeads have good application in serum index detection to increase detection efficiency.

Impact of the COVID-19 pandemic on the treatment of acute cholangitis caused by choledocholithiasis: A single-center retrospective study in Japan.

This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the treatment of acute cholangitis caused by choledocholithiasis. The Japanese government declared a state of emergency in April 2020 due to the COVID-19 pandemic. We retrospectively reviewed the medical records of 309 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis caused by choledocholithiasis between April 2017 and December 2022. Patients were categorized into a pregroup (n = 134) and a postgroup (n = 175), depending on whether they were diagnosed before or after the state of emergency declaration. The total number of ERCP cases and the number of ERCP cases with endoscopic stone removals increased after the state of emergency declaration. Compared with the pregroup, the numbers of patients with performance status of 0-1 and surgically altered anatomy increased, whereas the numbers of patients taking oral antiplatelets or anticoagulants and those with cerebrovascular disease decreased in the postgroup. The number of single-stage endoscopic stone removals increased and hospital stays were significantly shorter in the postgroup. No differences in adverse event rates were detected between the two groups. Although our hospital provides tertiary care, the number of patients with cholangitis in good general condition and no underlying disease increased after the state of emergency declaration. The COVID-19 pandemic resulted in an increase in the number of single-stage endoscopic treatments and shortened hospital stays for patients with acute cholangitis caused by choledocholithiasis. No safety issues with ERCP were detected, even during the pandemic.

Biliary cast syndrome developed after treatment for acute cholangitis: progression to secondary sclerosing cholangitis

Biliary cast syndrome developed after treatment for acute cholangitis: progression to secondary sclerosing cholangitis

Laparoscopic versus Conventional Surgery for Acute Cholangitis of Severe Type: A Systematic Review of Randomized Controlled Trials.

Objective Currently, the choice between laparoscopic surgery and conventional laparotomy in the surgical treatment of acute cholangitis of severe type (ACST) is debatable. This study compared the clinical efficacy of these two surgical methods through a meta-analysis based on relevant clinical randomized controlled trials (RCT) on ACST. Methods We systematically searched several databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and WangFang) for RCT on the surgical treatment of ACST between 2010 and 2022. Relevant data were extracted, and a meta-analysis was performed using the statistical software Stata 16.0. Results From initial 1089 studies retrieved, 15 studies (n = 1247 patients) were eligible. The total number of patients was 1247, of whom 635 were classified in the treatment group (laparoscopic surgery) and 612 patients in the control group (conventional laparotomy). This meta-analysis showed that compared with conventional laparotomy, laparoscopic surgery was associated with higher effective rate (OR = 3.808, 95% CI [2.383, 6.085], P < 0.001), lower incidence rate of complications (OR = 0.192, 95% CI [0.139, 0.265], P < 0.001), shorter operation duration (SMD = −3.274, 95% CI [-4.503, -2.045], P < 0.001), and shorter postoperative hospital stay (SMD = −2.432, 95% CI [-2.988, -1.877], P < 0.001). Further, the indicators of symptomatic relief (anus exhaust time, jaundice relief time, gastrointestinal function recovery time, and abdominal pain relief time) and inflammatory levels (white blood cell count, alanine aminotransferase, total bilirubin level, and high-sensitivity C-reactive protein level) in the treatment group were better than those in the control group. Conclusion Laparoscopic surgery was associated with significant improvement in treatment efficiency, reduced risk of complications, and better treatment outcomes in patients with ACST.

Diagnosis and Treatment of Acute Cholangitis

Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It can be a life-threatening condition if it is not recognized early. Patients with severe cholangitis may present with hypotension, and mental status changes. The most frequent causes of acute cholangitis are biliary calculi, benign biliary stricture, and malignancy. The most common pathogens isolated are gram-negative bacteria (&lt;i&gt;Escherichia coli&lt;/i&gt; , followed by &lt;i&gt;Klebsiella&lt;/i&gt; species and &lt;i&gt;Enterobacter&lt;/i&gt; species). A diagnosis of acute cholangitis requires evidence of systemic inflammation, cholestasis, and imaging with biliary obstruction. Imaging studies may consist of ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound. The mainstay of treatment consists of fluid resuscitation, antibiotics, and biliary drainage. Penicillin/β-lactamase, third-generation cephalosporin, or carbapenem are all acceptable choices for first-line treatment. In patients with severe cholangitis, biliary drainage should be performed within 24 hours. Patients with severe acute cholangitis require urgent (within 24 hours) biliary decompression. Endoscopic retrograde cholangiopancreatography remains the preferred modality for biliary drainage. In conclusion, acute cholangitis is mostly treatable when recognized and treated early. Recognizing and initiating early treatment leads to markedly decreased patient morbidity and mortality.

S1597 A Rare Presentation of Lemmel’s Syndrome as Acute Cholangitis With Acute Pancreatitis

Introduction: Duodenal diverticula are most commonly found in the second part of the duodenum adjacent to the ampulla of Vater. Periampullary diverticula (PAD) are extraluminal pseudo-diverticula lacking a mucosal layer. Although typically asymptomatic, they can rarely cause pancreaticobiliary obstruction. Obstructive jaundice can develop secondary to PAD without choledocholithiasis, a rare phenomenon called Lemmel’s Syndrome. We report a rare case of Lemmel’s syndrome presenting not only with acute cholangitis but also with concurrent pancreatitis, successfully treated with ERCP. Case Description/Methods: An 83-year-old female presented with upper abdominal pain, nausea, diarrhea, and rigors. She is s/p cholecystectomy and labs revealed AST 688 U/L, ALT 305 U/L, Alkaline Phosphatase 201 U/L, total bilirubin 3.4 mg/dL, lipase 968 U/L, and lactate 2.9 mmol/L. An abdominal CT scan showed severe dilation of the common bile duct of 2.1 cm with edematous appearance of the pancreatic head, findings of acute pancreatitis, and a large duodenal diverticulum adjacent to the pancreatic head (Fig 1). Her hospital course was complicated by gram negative bacteremia, concerning for acute cholangitis. MRCP confirmed marked dilation of the common bile duct extending to the Ampulla of Vater with a large periampullary diverticulum, without choledocholithiasis or mass lesions (Fig 2). The patient underwent ERCP which revealed a large duodenal diverticulum compressing the distal bile duct, treated with biliary sphincterotomy and stent placement (Fig 3-4). She showed gradual clinical improvement with this endoscopic approach and was discharged home with subsequent follow up for stent removal performed 6 weeks later. Discussion: Although common among duodenal diverticula, PAD are rarely symptomatic. The underlying pathogenesis remains unclear but is believed to be related to mechanical obstruction, inflammation, and fibrosis. Lemmel’s syndrome can be mistaken for pseudocysts, necrotic collections, periampullary tumors, and pancreatic head neoplasms. Physicians should have a high index of suspicion for Lemmel’s syndrome in patients with large symptomatic PAD, which although commonly presents as biliary obstruction causing acute cholangitis, can rarely also cause pancreatic obstruction leading to pancreatitis, as seen in our patient. Timely diagnosis and endoscopic treatment of Lemmel’s syndrome can be effective in the treatment of acute cholangitis and pancreatitis.Figure 1.: CT scan showing CBD dilation with large periampullary diverticulum.Figure 2.: MRI showing dilated CBD and PD with distal large periampullary diverticulum.Figure 3.: Endoscopic view of large periampullary diverticula with intradiverticular papilla seen on ERCP.Figure 4.: Fluoroscopic view of dilated CBD as a result of Lemmel’s syndrome.

Сочетание применения эндоскопических и лапароскопических методик при лечении больных острым холангитом

Актуальность. Лечебные мероприятия при остром холангите обязательно должны предусматривать два главных направления: устранение билиарной гипертензии и борьбу с инфекцией в желчевыводящих путях. Без своевременного адекватного лечения это заболевание ведет к летальному исходу. При остром холангите любое хирургическое вмешательство, которое обеспечивает достаточное дренирование желчного дерева, считается адекватным, так как ликвидирует одно из принципиальных звеньев (билиарная гипертензия) в цепи патогенеза острого холангита. По мере достижения ликвидации острого процесса проводится коррекция причин возникновения острого холангита для предупреждения последующих билиарных осложнений. Применение лапароскопических методик проведения хирургических вмешательств при возникновении острого холангита в большинстве случаев ограничивается только проведением лапароскопической холецистэктомии после устранения явлений холангита. Цель. Усовершенствование применения комплекса лапароскопических и эндоскопических хирургических вмешательств при лечении больных острым холангитом. Материалы и методы. Лапароскопические и видеоассистированные операции проведены у 125 больных острым холангитом в разные сроки по отношению к эндоскопическим трансдуоденальным вмешательствам. В общей сложности указанным пациентам проведено 151 видеолапароскопическое и 102 эндоскопических хирургических вмешательства. Среди них эндоскопические: эндоскопическая папиллосфинктеротомия — 102, в том числе: механическая литотрипсия — 87, литоекстракция — 25; видеолапароскопические: лапароскопическая холецистэктомия — 113, лапароскопическая холецистостомия — 12, лапароскопическое вскрытие и дренирование холангиогенных абсцессов печени — 9, лапароскопическое и видеоассистированное дренирование холедоха — 8, лапароскопическая и видеоассистированная холедохолитотомия — 5, лапароскопическая и видеоассистированная холецистоеюностомия — 4. Результаты. Послеоперационные осложнения возникли у 9 (7,2 %) больных. Летальных исходов не было. Лапароскопические хирургические вмешательства и эндоскопические транспапиллярные вмешательства проведены в разной последовательности в зависимости от наличия деструктивных изменений в желчном пузыре и дополняли друг друга. Выводы. Оперативные вмешательства с использованием видеолапароскопических технологий позволяют в большинстве случаев устранить билиарную гипертензию как один из патогенетических факторов острого холангиту, а также причину его возникновения.

Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen

Malignant tumor-associated acute abdomen refers to a non-perioperative acute abdominal disease caused by malignant tumors or caused by various anti-tumor treatments with acute abdominal pain as the main clinical manifestation. It is often critical and even life-threatening. For patients with malignant tumor-associated acute abdomen, the occurrence and development of tumors and the evolution of acute complications are often causal to each other. Therefore, diagnosis and treatment of malignant tumor-associated acute abdomen usually require the surgery-based multidisciplinary treatment (MDT). According to imaging features and access to medical resources, oncologists and surgeons, working with other relevant professional teams need to develop the most appropriate treatment strategy through hierarchical management based on different oncology assessments and treatment goals. Yet there is no consensus on diagnosis and treatment of malignant tumor-associated acute abdomen. Therefore, Chinese College of Surgeons, Chinese Society for Clinical Oncologists, Chinese Society of Multidisciplinary Team, and the Chinese Journal of Gastrointestinal Surgery gathered multidisciplinary experts in China to discuss and develop the Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen. This consensus consists of three parts, namely multidisciplinary diagnosis and evaluation, multidisciplinary prevention and treatment, and specific treatment of common malignant tumor-associated acute abdomen. The diagnosis and evaluation section mainly includes oncology, imaging diagnosis and surgical perioperative evaluation. The prevention and treatment section mainly includes the prevention of malignant tumor-associated acute abdomen, the principle of treatment based on surgery, anti-tumor therapy-induced acute abdomen, as well as the prevention and management of special biological types of malignant tumor-associated acute abdomen. The last part discusses specific treatment of malignant tumor-associated acute abdomen such as gastrointestinal obstruction (surgery, palliative care, endoscopic or interventional surgery), gastrointestinal perforation (perioperative and surgical treatment), gastrointestinal bleeding (medical treatment, endoscopic surgery, interventional surgery, and surgical treatment), biliary system-associated acute abdomen (treatment of acute cholangitis, acute cholecystitis, and gallbladder perforation), and rupture of liver cancer (general treatment, transarterial embolization, and surgical treatment). We hope this consensus will help clinicians to understand the multidisciplinary standardized diagnosis and treatment of patients with malignant tumor-associated acute abdomen and to serve as a practical reference.

Shortening antibiotic duration in the treatment of acute cholangitis: rationale and study protocol for an open-label randomized controlled trial

BackgroundAntimicrobial therapy with appropriate biliary drainage is considered the standard of care for acute cholangitis, but the optimal duration of antimicrobial therapy remains unknown. Seven to 10 days of antimicrobial therapy are common for the treatment of acute cholangitis, but a recent retrospective cohort study suggested a shorter duration might be effective. A shorter duration of antimicrobial therapy can be beneficial in decreasing the length of hospital stay, improving patients’ quality of life, decreasing adverse effects, and even contributing to a decrease in the occurrence of antimicrobial resistance.Methods/designWe will conduct a multi-centre, open-label, randomized, non-inferiority trial to compare short-course therapy (SCT) with conventional long-course therapy (LCT) in treating patients with acute cholangitis. SCT consists of 5-day intravenous antimicrobial therapy if the patients had clinical improvement, while at least 7 days of intravenous antibiotics will be provided to the LCT group. The primary outcome is clinical cure at 30 days after onset. Patients will be randomly assigned in an open-label fashion. A total sample size of 150 was estimated to provide a power of 80% with a one-sided α level of 2.5% and a non-inferiority margin of 10%.DiscussionThis trial is expected to reveal whether SCT is non-inferior to conventional LCT or not, and may provide evidence that one can shorten the treatment duration for acute cholangitis for the benefit of patients.Trial registrationUniversity Hospital Medical Information Network, UMIN000028382. Registered on 30 August 2017.

GALLBLADDER WALL CONDITION IN THE LONG-TERM AFTER ENDOSCOPIC TRANSPAPILLARY INTERVENTIONS

The aim of research. Study changes in the gallbladder wall in the long-term (more than 7days) after endoscopic transpapillary interventions on the common bile duct.Material and methods. Preparations of the 29 gallbladder wall, operatively removedmore than 7 days after endoscopic transpapillary interventions on the common bile ductwere painted with hematoxylin-eosin and pyrofuksin by Van Gison, the thickness ofmechanically strong structures (muscle layers, collagen) and mechanically weakstructures (intermediate edema, areas of necrosis, areas of leukocyte infiltration) of thegallbladder wall.Results. In terms more than 7 days after endoscopic transpapillary surgical interventionthe following types of changes in the gallbladder wall: "infiltrative sclerotic" and"restorative" were revealed. Basically, collagen structures and leukocyte infiltration havebeen detected in the period from 7 to 18 days following endoscopic transpapillaryintervention on the common bile duct in the gallbladder wall and distant surroundingtissues on the serous membrane side, that indicates strong adhesions with surroundingstructures against a background of pronounced inflammatory response in the area of thecystic duct and cystic artery ("infiltrative sclerotic" type). After 18 days followingendoscopic transpapillary interventions on the common bile duct signs of restoration ofthe structure of the gall bladder wall ("restorative" type of changes in the wall of the gallbladder) are observed.Conclusions. Standard therapy in preparation for the second stage of surgical treatmentof acute cholangitis in some cases does not restore the gallbladder wall and its strength,which is associated with varying degrees of inflammation, necrosis, atrophy, sclerosis ofthe gallbladder wall after endoscopic transpapillary intervention, as well as individualboth regenerative and immune capabilities. Changes in the gallbladder wall can bedescribed as changes in the "infiltrative sclerotic" and "restorative" types.

A case of cystic duct carcinoma diagnosed after treatment for acute cholangitis

A case of cystic duct carcinoma diagnosed after treatment for acute cholangitis

Treatment of acute cholangitis caused by benign processes in the major duodenal papilla

Objective: to improve the surgical treatment of acute cholangitis caused by benign tumors in the area of the major duodenal papilla.Material and methods. Analysis of the surgical treatment of 83 patients with acute cholangitis arising from benign diseases in the area of the major duodenal papilla was made. Among them, there were 49 men and 34 women. The average age of patients was 49.7 ± 6.9 years. According to the nosological forms, it looked as follows: papillary stenosis — 51, adenomas of the major duodenal papilla — 13, parapapillary duodenal polyps — 12, diverticulum of the duodenum in the area of the major duodenal papilla — 5, peptic duodenal ulcer — 2.Results. Acute cholangitis in papillary stenosis, adenoma of the major duodenal papilla, parapapillary polyps was eliminated using endoscopic transduodenal techniques with the removal of the immediate cause of acute cholangitis. For this used endoscopic papillo-sphincterotomy, endoscopic mechanical lithotripsy, lithoextraction, electroexcision of polyps and adenomas. Among 83 patients, 19 (22,9%) patients had to perform 2 or more endoscopic transpapillary interventions. The greatest difficulties were in the cannulation of the major duodenal papilla in patients with parapapillary ulcers and duodenal diverticulum. Two patients underwent laparoscopic and two patients underwent open surgical interventions. Among 83 patients treated with acute cholangitis on the background of benign pathology of the major duodenal papilla, 11 (13,3%) had different complications. Conclusions. Acute cholangitis in papillary stenosis, adenoma of the major duodenal papilla and parapapillary polyps with concomitant choledocholithiasis can be completely treated exclusively with endoscopic interventions (if necessary — multiple) with a small number of complications (13,3%). Treatment of acute cholangitis on the background of parapapillary ulcers and duodenal diverticulum in most cases requires the use not only endoscopic transduodenal techniques, but also the use of laparoscopic biliary and open resection surgical interventions.

Comparison between endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage in treatment of acute cholangitis

Objective To compare the safety and effectiveness of endoscopic retrograde biliary drainage (ERBD) and endoscopic nasobiliary drainage (ENBD) in treatment of acute cholangitis. Methods A retrospective analysis was performed on data of 272 patients with acute cholangitis who underwent emergent endoscopic retrograde cholangiopancreatography (ERCP) in Beijing Chaoyang Hospital from January 2009 to June 2017. Patients were divided into ERBD group (n=143) and ENBD group (n=129) according to the drainage measures. In the ERBD group, there were 63 cases of grade Ⅰ (mild) acute cholangitis, 51 of grade Ⅱ (moderate), and 29 of grade Ⅲ (severe), and the corresponding cases in the ENBD group were 54, 37 and 38, respectively. The rate of improvement of inflammation, ERCP-related complications and interventions to drainage were compared between the two groups in all patients and each grade. Results The rates of improvement of inflammation in the ERBD group and the ENBD group were 89.5% (128/143) and 94.6% (122/129), respectively, in overall patients (χ2=2.399, P=0.126), 93.7% (59/63) and 98.1% (53/54), respectively, in grade Ⅰ patients (χ2=0.548, P=0.459), 90.2% (46/51) and 94.6% (35/37), respectively, in grade Ⅱ patients (χ2=0.125, P=0.724), and 79.3% (23/29) and 89.5% (34/38), respectively, in grade Ⅲ patients (χ2=0.657, P=0.418). The incidence of ERCP-related complications in the ERBD group and the ENBD group were 11.9% (17/143) and 7.8% (10/129), respectively, in overall patients (χ2=1.298, P=0.225), 9.5% (6/63) and 7.4% (4/54), respectively, in grade Ⅰ patients (χ2=0.006, P=0.939), 13.7% (7/51) and 8.1% (3/37), respectively, in grade Ⅱ patients (χ2=0.230, P=0.632), and 13.8% (4/29) and 7.9% (3/38), respectively, in grade Ⅲ patients (χ2=0.144, P=0.705). There were no significant differences in the rate of improvement of inflammation and ERCP-related complications between the two groups. The incidences of interventions to drainage in the ERBD group and the ENBD group were 10.5% (15/143) and 3.1% (4/129), respectively, in overall patients (χ2=5.699, P=0.017), 6.3% (4/63) and 1.9% (1/54), respectively, in grade Ⅰ patients (χ2=0.548, P=0.495), 9.8% (5/51) and 5.4% (2/37), respectively, in grade Ⅱ patients (χ2=0.125, P=0.724), and 20.7% (6/29) and 2.6% (1/38), respectively, in grade Ⅲ patients (χ2=3.965, P=0.046). There were significant differences in the incidence of interventions to drainage between the two groups in overall and grade Ⅲ patents. Conclusion ERBD and ENBD are equally safe and effective in treatment of different grades of acute cholangitis, but ENBD can reduce the incidence of interventions to drainage. Key words: Cholangiopancreatography, endoscopic retrograde; Stent; Nasobiliary drainage; Acute cholangitis

Experience of treatment of acute cholangitis with the use of anti-bacterial photodynamic therapy

Introduction. Acute cholangitis is a life-threatening disease characterized by an ascending inflammatory and infectious process in the biliary tree. Biliary decompression and systemic or local antibiotic therapy are key points in the treatment of acute cholangitis, regardless of the etiology of the disease. At the same time, an evergrowing antibacterial resistance requires the search for new ones, including non-pharmacological methods of combating infectious agents, one of which is photodynamic therapy. The aim of the work is to assess the effectiveness of the use of antibacterial photodynamic therapy in the complex treatment of acute cholangitis. Materials and methods. The paper presents the experience of using antibacterial photodynamic therapy in the complex treatment of acute cholangitis in 7 patients with obstructive jaundice. Standard methods of percutaneous transhepatic cholangiosis and conservative treatment of acute cholangitis were supplemented by intraductal antibacterial photodynamic therapy according to the technique developed by the authors. Photolon (Belmedpreparaty, Republic of Belarus) was used as a photosensitizer. The radiation was supplied through a quartz-polymer fiber with a diameter of 400 μm. The radiation wavelength is λ = 660 nm, the radiation power is 50 mW. The exposure time is 5–7 minutes. Results. The bactericidal effect of antibacterial photodynamic therapy was established, expressed in a statistically significant decrease in microbial contamination in bile already on the 3rd day of the study with its complete eradication on the 6th day of the study (p &lt; 0.05). The average treatment time for acute cholangitis was 11.2 ± 2.4 days. Findings. Thus, the use of bile duct drainage in combination with intraductal antibacterial photodynamic therapy allows to stop the cholangitis phenomenon, reduce the economic costs of treatment, as well as the subsequent rehabilitation of this category of patients.

Treatment for acute cholangitis

Treatment for acute cholangitis

東京ガイドライン2013（TG13）による急性胆管炎・胆嚢炎診療

東京ガイドライン2013（TG13）による急性胆管炎・胆嚢炎診療

Emergency duodenoscopy for diagnosis and treatment of acute cholangitis with choledocholithiasis in elderly patients

Emergency duodenoscopy for diagnosis and treatment of acute cholangitis with choledocholithiasis in elderly patients

Su1671 Utility and Problems of Linear Array EUS and ERCP for Diagnosis and Treatment of Acute Cholangitis in Over 80 Years High Elderly Patients

Su1671 Utility and Problems of Linear Array EUS and ERCP for Diagnosis and Treatment of Acute Cholangitis in Over 80 Years High Elderly Patients

Su1675 Utility and Problems of EUS and ERCP At One Session for Clinical Management of Acute Cholangitis

Since acute cholangitis(AC) is sudden onset syndrome and has risk for developing severe infection that can be fatal, we usually need to provide appropriate medical care at early stage. ERCP or EUS are indispensable for prompt diagnosis and treatment for AC. Some reports have indicated the superiority of linear array EUS in detection of biliary tract lesions and contribute correct diagnosis for because of the high resolution of images. In this study we evaluated the utility and problems of EUS and ERCP at one session.

TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis

While referring to the evidence adopted in the Tokyo Guidelines 2007 (TG07) as well as subsequently obtained evidence, further discussion took place on terminology, etiology, and epidemiological data. In particular, new findings have accumulated on the occurrence of symptoms in patients with gallstones, frequency of severe cholecystitis and cholangitis, onset of cholecystitis and cholangitis after endoscopic retrograde cholangiopancreatography and medications, mortality rate, and recurrence rate. The primary etiology of acute cholangitis/cholecystitis is the presence of stones. Next to stones, the most significant etiology of acute cholangitis is benign/malignant stenosis of the biliary tract. On the other hand, there is another type of acute cholecystitis, acute acalculous cholecystitis, in which stones are not involved as causative factors. Risk factors for acute acalculous cholecystitis include surgery, trauma, burn, and parenteral nutrition. After 2000, the mortality rate of acute cholangitis has been about 10 %, while that of acute cholecystitis has generally been less than 1 %. After the publication of TG07, diagnostic criteria and severity assessment criteria were standardized, and the distribution of cases according to severity and comparison of clinical data among target populations have become more subjective. The concept of healthcare-associated infections is important in the current treatment of infection. The treatment of acute cholangitis and cholecystitis substantially differs from that of community-acquired infections. Cholangitis and cholecystitis as healthcare-associated infections are clearly described in the updated Tokyo Guidelines (TG13). Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.