Bacterial infection that occurs in the setting of biliary obstruction can lead to acute cholangitis, a condition characterized by fever, abdominal pain and jaundice. Choledocholithiasis is the most common cause of acute cholangitis and is often associated with bacterial infection and colonization in addition to biliary obstruction. Iatrogenic introduction of bacteria into the biliary system most commonly occurs during endoscopic retrograde cholangiopancreatography in patients with biliary obstruction. The majority of patients with acute cholangitis respond to antibiotic therapy, but endoscopic biliary drainage is ultimately required to treat the underlying obstruction. Acute cholangitis is often diagnosed using the clinical Charcot triad criteria; however, recommendations from an international consensus meeting in Tokyo produced the most comprehensive recommendations for the diagnosis and management of acute cholangitis. These guidelines enable a more accurate diagnosis of acute cholangitis than do earlier methods, and they facilitate the classification of disease as mild, moderate or severe. Although these guidelines represent a notable advance toward defining a universally accepted consensus for the definition of acute cholangitis, they have several limitations. This Review discusses current recommendations for the diagnosis of acute cholangitis and addresses the advantages and disadvantages of different modalities for the treatment of this disease.
Diagnosis of acute cholangitis has traditionally been made by the Charcot triad criteria; that is, clinical findings of fever, biliary tract pain and jaundice
Approximately 80% of patients with acute cholangitis respond to broad-spectrum antibiotics alone while the remainder require early biliary drainage in addition to antibiotic therapy
Endoscopic retrograde cholangiopancreatography (ERCP) and stent placement are considerably safer than surgical biliary decompression
Elective cholecystectomy should be performed after resolution of acute cholangitis in patients with an intact gallbladder
Meticulous disinfection and ERCP techniques are required to avoid the development of acute cholangitis in patients with biliary obstruction who undergo ERCP
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The author declares no competing financial interests.
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Lee, J. Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol 6, 533–541 (2009). https://doi.org/10.1038/nrgastro.2009.126
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