ASGE guideline on the management of cholangitis.

Published on Aug 1, 2021in Gastrointestinal Endoscopy9.427
· DOI :10.1016/J.GIE.2020.12.032
James Buxbaum26
Estimated H-index: 26
(SC: University of Southern California),
Carlos Buitrago1
Estimated H-index: 1
(SC: University of Southern California)
+ 21 AuthorsSachin Wani71
Estimated H-index: 71
(Anschutz Medical Campus)
Sources
Abstract
Cholangitis is a GI emergency requiring prompt recognition and treatment. The purpose of this document from the American Society for Gastrointestinal Endoscopy's (ASGE) Standards of Practice Committee is to provide an evidence-based approach for management of cholangitis. This document addresses the modality of drainage (endoscopic vs percutaneous), timing of intervention ( 48 hours), and extent of initial intervention (comprehensive therapy vs decompression alone). Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to formulate recommendations on these topics. The ASGE suggests endoscopic rather than percutaneous drainage and biliary decompression within 48 hours. Additionally, the panel suggests that sphincterotomy and stone removal be combined with drainage rather than decompression alone, unless patients are too unstable to tolerate more extensive endoscopic treatment.
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Abstract Background and Aims Acute cholangitis (AC) is characterized by abdominal pain, fever, and jaundice. The majority of the patients respond to medical management with intravenous hydration and antibiotics. Almost 20% to 30% require biliary drainage, and ERCP is the procedure of choice. We conducted a systematic review and meta-analysis to evaluate the impact of emergent biliary drainage on patients' outcomes. Methods A comprehensive literature review was conducted by searching the Embase a...
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Background Biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for acute cholangitis. Despite the established effectiveness of urgent biliary drainage in patients with severe acute cholangitis, the indication of this procedure for non-severe acute cholangitis is controversial.
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Acute cholangitis mandates resuscitation, antibiotic therapy, and biliary decompression. Our aim was to define the optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute cholangitis. Clinical data on all cases of cholangitis managed by ERCP were prospectively collected from September 2010 to July 2013. The clinical impact of the time to ERCP, defined as the time from presentation in the emergency department to the commencement of the ERCP, was determined....
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Background Acute cholangitis in old people is a cause of mortality and prolonged hospital stay. We evaluated the effects of methods and timing of biliary drainage on the outcomes of acute cholangitis in elderly and very elderly patients. Methods We analyzed 331 patients who were older than 75 years and were diagnosed with acute calculous cholangitis. They were admitted to our hospital from 2009 to 2014. Patients' demographics, severity grading, methods and timing of biliary drainage, mortality, ...
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Cited By1
Newest
#1James Buxbaum (SC: University of Southern California)H-Index: 26
#2Bashar J. Qumseya (UF: University of Florida)H-Index: 22
Last. Sachin Wani (Anschutz Medical Campus)H-Index: 71
view all 3 authors...
Abstract BACKGROUND AND AIMS Despite improvements in imaging and laboratory medicine, consensus criteria for the diagnosis of cholangitis are lacking. Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective treatment for cholangitis, it should be reserved for those patients with a high probability of the diagnosis, given the morbidity associated with the procedure. METHODS A comprehensive literature search of PubMed (coverage 1898-present), Web of Science (1900-July 15, 20...
Source
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