Endoscopic Management Of Acute Calculous Cholangitis

Acute cholangitis is associated with significant morbidity and mortality. Endoscopic drainage procedures have been shown to be a safe and effective mode of treatment in acute cholangitis. As there is paucity of large series on endoscopic management of acute cholangitis, a study was performed to evaluate safety and efficiency of endoscopic biliary decompression in acute cholangitis, The study included 89 consecutive patients (mean age 55 +/- 15 years; range 35-70 years; 50 males) with acute cholangitis requiring biliary drainage. Main presenting features were upper abdominal pain (84%), fever with chills (90%) and jaundice (74%). Altered sensorium, hypotension, features of peritonitis and acute renal failure were present in 15, 11, 18 and 5%, respectively. Endoscopic procedures performed were endoscopic sphincterotomy (ES) with stone extraction (n = 40); ES with endoscopic nasobiliary drainage (END; n = 30); ENBD without ES (n = 8); and ES with stent placement (n = 11). Of the 89 patients, 85 (95%) responded within 45-72 h. Endoscopic common duct clearance could be achieved in 58 of 78 (74%) patients, whereas in 11 patients undergoing stent placement, stone extraction was not: attempted. Complications included post-sphincterotomy bleed (n = 2), retroduodenal perforation (n = 1) and acute pancreatitis (n = 1) with an overall complication rate of 4.4%. All the complications were seen in patients undergoing ES with stone extraction. Mortality was 3.3%, In conclusion, endoscopic biliary drainage is a safe and effective mode of treatment for acute cholangitis, Endoscopic nasobiliary drainage or stent placement is safer than ES in acute cholangitis as an initial step.