The Emergency Medicine−Focused Review of Cholangitis

Ely, Rachel; Long, Brit; Koyfman, Alexander

doi:10.1016/j.jemermed.2017.06.039

Cited by 17 publications

(9 citation statements)

References 41 publications

(93 reference statements)

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“… 3 Most emergency ERCP procedures are performed in patients with acute cholangitis associated with biliary stones, benign or malignant biliary strictures, and stent obstruction. 4 , 5 Moreover, the pain caused by biliary obstruction and acute gallstone pancreatitis with cholangitis is an indication for emergency ERCP. 6 , 7 Although ERCP usually improves symptoms dramatically, it can also worsen symptoms and cause serious complications.…”

mentioning

confidence: 99%

Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases

et al. 2022

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Objective The aim of this study was to identify the incidence of and risk factors for post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after emergency endoscopic retrograde cholangiopancreatography (ERCP). Methods We performed a prospective multicenter observational study of 3914 patients who underwent ERCP. We compared the incidence of PEP after emergency and elective ERCP. Results A total of 3410 patients were enrolled in this study. Post-ERCP pancreatitis occurred in 44 of 800 patients (5.5%) and in 190 of 2418 patients (7.9%) in the emergency and elective groups, respectively. No significant difference was noted between the groups (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.52–1.03; P = 0.07). Multivariate analysis showed that the following factors increased the risk for PEP after emergency ERCP: contrast medium injection into the pancreatic duct (OR, 2.56; 95% CI, 1.30–5.03; P = 0.005), >4 cannulation attempts (OR, 5.72; 95% CI, 2.61–12.50; P < 0.001), and endoscopic papillary balloon dilatation (OR, 9.24; 95% CI, 2.13–40.10; P < 0.001). Conclusions No significant difference was noted in the incidence of PEP in patients after emergency and elective ERCP. We may prevent PEP even after emergency ERCP by avoiding contrast injection into the pancreatic duct, multiple cannulation attempts, and endoscopic papillary balloon dilatation.

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confidence: 99%

Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases

et al. 2022

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“…7 of hypotension and altered mental status (Reynold's pentad) are seen in only 5%-7% of cases, but typically represent more severe disease when present. 6,7 Charcot's triad has low sensitivity (26.4%) and Charcot's triad is suggestive of acute cholangitis, it is not diagnostic. However, some patients may not manifest all the symptoms and signs.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Incidence of cholangitis is associated with prevalence of cholelithiasis. 6 Gallstones are found in 10% to 15% of the white population in the United States. It is much more prevalent in native Americans (60%-70%) and Hispanics but less common in Asians and African Americans.…”

Section: Epidemiologymentioning

confidence: 99%

“…Of those with asymptomatic gallbladder stones, approximately 0.6%-1.3% will go on to develop cholangitis over a 10year period. 6 Males and females are equally affected. The average age of patients presenting with acute cholangitis is 50 to 60 years.…”

Section: Epidemiologymentioning

confidence: 99%

“…4 Bacteria primarily enter the biliary system by ascending from the duodenum into the common hepatopancreatic duct (hence the terms ascending and suppurative cholangitis). 6,9 The portal venous system and the periportal lymphatic system are also potential routes of entry, which is thought to occur less frequently. The mere presence of bacteria in the biliary system, symptoms without coexistent obstruction due to effective immunoglobulin (Ig) A secretion protecting Kupffer cell function and integrity of biliary tight junctions.…”

Section: Pathophysiologymentioning

confidence: 99%

See 2 more Smart Citations

Acute Cholangitis: An Update in Management Based on Severity Assessment

Christeven¹,

Frandy²,

Andersen³

2020

InaJGHE

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Acute cholangitis (AC) is a biliary tract emergency which causes significant morbidity and mortality. The direct cause of death in AC is sepsis that leads to irreversible shock and multiple organ failure. The most common predisposition are bile duct stones and previous invasive manipulation of the biliary tree. Biliary infection and biliary obstruction are the two main factors in pathophysiology of AC. Gram-negative bacteria are isolated frequently from bile and blood culture in cholangitis. The most common cause of biliary obstruction is gallstone.The Charcot’s triad which commonly has been used to diagnose AC is severely limited and the clinical presentation of the disease has wide spectrum ranging from mild symptoms to severe life-threatening disease. Thus, the use of the most updated Tokyo Guidelines (TG18) is imperative to diagnose the disease and to assess the severity. The TG18 diagnostic criteria is based on the presence of systemic inflammmation, cholestasis, and evidence on imaging studies of biliary tract. The prompt treatment is tailored according to severity assessed by TG18. Initial treatment includes sufficient fluid replacement, hemodynamic control, electrolyte compensation, intravenous antibiotic administration, and intravenous analgesic administration. The definitive treatment which related to the pathophysiology of the disease are biliary drainage and antibiotic administration.

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Abdominal/Gastroenterology Emergencies

Callahan¹

2022

Emergency Medicine Simulation Workbook

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The Emergency Medicine−Focused Review of Cholangitis

Cited by 17 publications

References 41 publications

Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases

Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases

Acute Cholangitis: An Update in Management Based on Severity Assessment

Abdominal/Gastroenterology Emergencies

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