Management of Cholangitis

Patient Guideline Summary

Publication Date: July 31, 2021

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the American Society for Gastrointestinal Endoscopy (ASGE) for the management of cholangitis. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Cholangitis is an infection of the gallbladder due to an obstructed duct, usually by a gallstone. It is a life-threatening emergency.
Symptoms include jaundice (yellow coloring of the skin and the white part of the eyes), fever, and pain under the right ribs.
This patient summary focuses on the endoscopic management of cholecystitis.

Treatment

Antibiotics are standard medical care, but the surgical opening of the obstructed duct is usually required.
ASGE prefers endoscopic retrograde cholangiopancreatography (ERCP) over percutaneous transhepatic biliary drainage (PTBD).
ERCP should be done within 48 hours of diagnosis.
ASGE suggests that biliary drainage be combined with other maneuvers such as sphincterotomy and stone removal versus stent placement without attempted stone removal.

Glossary:
*ERCP describes inserting a long, flexible instrument through the mouth and into the upper part of the intestine. The instrument combines surgical tools with a scope.
*PTBD describes a similar procedure done through the skin and liver.
*Sphincterotomy describes an incision through the valve that connects the bile and pancreatic duct with the intestine to allow passage of the obstructing stone.
*A stent is a tube placed in a duct (or artery) that keeps it open.

Abbreviations

ASGE: American Society For Gastrointestinal Endoscopy
ERCP: Endoscopic Retrograde Cholangiopancreatography
PTBD: Percutaneous Transhepatic Biliary Drainage

Source Citation

Buxbaum JL, Buitrago C, Lee A, Elmunzer BJ, Riaz A, Ceppa EP, Al-Haddad M, Amateau SK, Calderwood AH, Fishman DS, Fujii-Lau LL, Jamil LH, Jue TL, Kwon RS, Law JK, Lee JK, Naveed M, Pawa S, Sawhney MS, Schilperoort H, Storm AC, Thosani NC, Qumseya BJ, Wani S. ASGE guideline on the management of cholangitis. Gastrointest Endosc. 2021 Aug;94(2):207-221.e14. doi: 10.1016/j.gie.2020.12.032. Epub 2021 May 20. PMID: 34023065.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.