ASGE guideline on the management of cholangitis.
Cholangitis is a GI emergency requiring prompt recognition and treatment. The purpose of this document from the American Society for Gastrointestinal Endoscopy's (ASGE) Standards of Practice Committee is to provide an evidence-based approach for management of cholangitis. This document addresses the modality of drainage (endoscopic vs percutaneous), timing of intervention (48 hours), and extent of initial intervention (comprehensive therapy vs decompression alone). Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to formulate recommendations on these topics. The ASGE suggests endoscopic rather than percutaneous drainage and biliary decompression within 48 hours. Additionally, the panel suggests that sphincterotomy and stone removal be combined with drainage rather than decompression alone, unless patients are too unstable to tolerate more extensive endoscopic treatment.
Buxbaum JL, Buitrago C, Lee A, Elmunzer BJ, Riaz A, Ceppa EP, Al-Haddad M, Amateau SK, Calderwood AH, Fishman DS, Fujii-Lau LL, Jamil LH, Jue TL, Kwon RS, Law JK, Lee JK, Naveed M, Pawa S, Sawhney MS, Schilperoort H, Storm AC, Thosani NC, Qumseya BJ, Wani S. ASGE guideline on the management of cholangitis. Gastrointest Endosc. 2021 Aug;94(2):207-221.e14. doi: 10.1016/j.gie.2020.12.032. Epub 2021 May 20. PMID: 34023065.