| Theme | Treatment of Choledocholithiasis | |
|---|---|---|
| Title | Acute Cholangitis | |
| Publish Date | 2017/01 | |
| Author | Ai Sato | Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University |
| Author | Atsushi Irisawa | Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University |
| Author | Goro Shibukawa | Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University |
| Author | Akane Yamabe | Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University |
| Author | Mariko Fujisawa | Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University |
| Author | Noriyuki Arakawa | Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University |
| [ Summary ] | The updated Tokyo Guidelines (TG13) based on evidence and consensus were published in 2013. They involved the revised new diagnostic criteria and the new severity assessment criteria. On the condition that biliary drainage is conducted as a rule, sufficient infusion and antimicrobial administration take place while fasting. TG13 focused primarily on empirical therapy, depending on the knowledge of local microbial epidemiology, susceptibility and patient‒specific factors that affect selection of appropriate agents. Once susceptibility is confirmed, specific therapy should be offered. TG13 recommended that endoscopic transpapillary biliary drainage should be selected as the first choice. The percutaneous transhepatic biliary drainage, surgical drainage, and EUS guided biliary drainage may be considered as alternative methods when endoscopic biliary drainage is difficult to conduct. | |