Single‐stage endoscopic treatment for mild to moderate acute cholangitis associated with choledocholithiasis: a multicenter, non‐randomized, open‐label and exploratory clinical trial

Eto, Kazunori; Kawakami, Hiroshi; Haba, Shin; Yamato, Hiroaki; Okuda, Toshinori; Yane, Kei; Hayashi, Tsuyoshi; Ehira, Nobuyuki; Onodera, Makoto; Matsumoto, Ryusuke; Matsubara, Yu; Takagi, Tomofumi; Sakamoto, Naoya

doi:10.1002/jhbp.296

Cited by 22 publications

(28 citation statements)

References 15 publications

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“…The TG13 flowchart proposed that for patients with moderate cholangitis, treatment for the underlying etiology should be provided electively after early biliary drainage, and that for patients with mild cholangitis due to choledocholithiasis, treatment for the underlying etiology such as endoscopic sphincterotomy (EST) and choledocholithotomy may be performed at the same time as biliary drainage . Three observational studies (one of which did not use severity assessment criteria) (CS) and one RCT showed that single‐stage lithotomy was safe and feasible in cases of mild or moderate acute cholangitis caused by choledocholithiasis. In the RCT, however, the rate of complications after endoscopic retrograde cholangiopancreatography (ERCP) was significantly higher than that after two‐stage lithotomy (6/35 = 17.1% vs. 0/33 = 0%, P = 0.025) (RCT) ; therefore, caution is required.…”

Section: Flowchart For the Initial Response To Acute Biliary Infectionmentioning

confidence: 99%

Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

Miura

Okamoto

Takada

et al. 2018

J Hepato Biliary Pancreat

287

229

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The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/ cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/ circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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Section: Flowchart For the Initial Response To Acute Biliary Infectionmentioning

confidence: 99%

Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

Miura

Okamoto

Takada

et al. 2018

J Hepato Biliary Pancreat

287

229

View full text Add to dashboard Cite

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“…). Most recently, Eto et al . evaluated the efficacy and safety of single‐step endoscopic treatment for mild to moderate acute cholangitis associated with CBDS.…”

Section: Discussionmentioning

confidence: 99%

“…2). Most recently, Eto et al 8 evaluated the efficacy and safety of single-step endoscopic treatment for mild to moderate acute cholangitis associated with CBDS. As a result, acute cholangitis resolved within 4 days after the endoscopic treatment in 90% of the patients.…”

Section: Diatal Hilarmentioning

confidence: 99%

Current strategies for endoscopic management of acute cholangitis

Isayama¹,

Yasuda

Tan

2017

Digestive Endoscopy

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Background and Aim: At the pancreatobiliary session of Endoscopic Forum Japan (EFJ) 2016, current strategies for the endoscopic management of acute cholangitis were discussed. The topics consisted of two major parts, namely endoscopic management of acute cholangitis caused by common bile duct stones (CBDS) and biliary stent occlusion. Methods:Endoscopists from nine Japanese high-volume centers along with two overseas centers participated in the questionnaires and discussion.Results: Strategies for management of cholangitis due to CBDS were agreed upon, and the clinical guideline of acute cholangitis (Tokyo guidelines 2013) was accepted. The best timing for drainage in Grade 2 (moderate) cholangitis urgent or early (<24 h) was inconclusive, and more data is required on this issue. Another controversy was the feasibility of one step stone extraction in the patient with cholangitis vs stone removal after the cholangitis had resolved. There were various opinions with regards to the management of acute cholangitis due to stent occlusion, and the strategies differed according to the stricture location (distal or hilar) and stent type initially placed (Covered or uncovered metal stent). Conclusion: Strategies for management of cholangitis causedby CBD stones are well established according to the TG13. More evidence is required before further recommendations can be made with regards to cholangitis due to stent occlusion. We aim to clarify this in the near future with questionnaires and consensus from experts.

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“…These findings may not always be applicable to mild‐to‐moderate cholangitis without coagulopathy. One multicenter prospective study and two retrospective studies of mild‐to‐moderate acute cholangitis associated with bile duct stone have shown that the cholangitis cure rate and the hemorrhagic complication rate of single‐session treatment are equivalent to those of two‐session treatment . Stone removal at a single session can shorten the hospital stay, thereby reducing medical cost and the patient's burden.…”

Section: Treatment Of Major Papilla and Removal Of Bile Duct Stonesmentioning

confidence: 99%

Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018

Mukai

Itoi

Baron

et al. 2017

J Hepato Biliary Pancreat

143

132

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The Tokyo Guidelines 2013 (TG13) include new topics in the biliary drainage section. From these topics, we describe the indications and new techniques of biliary drainage for acute cholangitis with videos. Recently, many novel studies and case series have been published across the world, thus TG13 need to be updated regarding the indications and selection of biliary drainage based on published data. Herein, we describe the latest updated TG13 on biliary drainage in acute cholangitis with meta-analysis. The present study showed that endoscopic transpapillary biliary drainage regardless of the use of nasobiliary drainage or biliary stenting, should be selected as the first-line therapy for acute cholangitis. In acute cholangitis, endoscopic sphincterotomy (EST) is not routinely required for biliary drainage alone because of the concern of post-EST bleeding. In case of concomitant bile duct stones, stone removal following EST at a single session may be considered in patients with mild or moderate acute cholangitis except in patients under anticoagulant therapy or with coagulopathy. We recommend the removal of difficult stones at two sessions after drainage in patients with a large stone or multiple stones. In patients with potential coagulopathy, endoscopic papillary dilation can be a better technique than EST for stone removal. Presently, balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is used as the first-line therapy for biliary drainage in patients with surgically altered anatomy where BE-ERCP expertise is present. However, the technical success rate is not always high. Thus, several studies have revealed that endoscopic ultrasonography-guided biliary drainage (EUS-BD) can be one of the second-line therapies in failed BE-ERCP as an alternative to percutaneous transhepatic biliary drainage where EUS-BD expertise is present.

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Single‐stage endoscopic treatment for mild to moderate acute cholangitis associated with choledocholithiasis: a multicenter, non‐randomized, open‐label and exploratory clinical trial

Cited by 22 publications

References 15 publications

Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

Current strategies for endoscopic management of acute cholangitis

Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018

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