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Review
. 2015 Jun;31(3):166-72.
doi: 10.1159/000430965. Epub 2015 Jun 11.

Acute Bacterial Cholangitis

Vincent Zimmer  1 , Frank Lammert  1
Affiliations
Review

Acute Bacterial Cholangitis

Vincent Zimmer et al. Viszeralmedizin. 2015 Jun.

Abstract

Background: Acute bacterial cholangitis for the most part owing to common bile duct stones is common in gastroenterology practice and represents a potentially life-threatening condition often characterized by fever, abdominal pain, and jaundice (Charcot's triad) as well as confusion and septic shock (Reynolds' pentad).

Methods: This review is based on a systematic literature review in PubMed with the search items 'cholangitis' 'choledocholithiasis' 'gallstone disease' 'biliary infection', and 'biliary sepsis'.

Results: Although most patients respond to empiric broad-spectrum antibiotic treatment, timely endoscopic biliary drainage depending on the severity of the disease is required to eliminate the underlying obstruction. Specific recommendations have been derived from the Tokyo guideline working group consensus 2006 and its update in 2013, albeit poorly evidence-based, providing a comprehensive overview of diagnosis, classification, risk stratification, and treatment algorithms in acute bacterial cholangitis.

Conclusion: Prompt clinical recognition and accurate diagnostic workup including adequate laboratory assessment and (aetiology-oriented) imaging are critical steps in the management of cholangitis. Treatment is directed at the two major interrelated pathophysiologic components, i.e. bacterial infection (immediate antimicrobial therapy) and bile duct obstruction (biliary drainage). As for the latter, transpapillary endoscopic drainage by stent or nasobiliary drain and/or same-session bile duct clearance, depending on individual disease severity, represent first-line treatment approaches.

Keywords: Cholangitis; Endoscopic retrograde cholangiography; Gallstone disease; Sepsis.

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Figures

Fig. 1
Fig. 1
Diagnostic algorithm in acute bacterial cholangitis. ERC = Endoscopic retrograde cholangiography; WBC = white blood cell; CRP = C-reactive protein; AP = alkaline phosphatase; γGT = γ-glutamyltransferase; ASAT = aspartate aminotransferase; ALAT = alanine aminotransferase.
Fig. 2
Fig. 2
Clinical TG13 flowchart for the management of acute cholangitis (reprinted with permission from [65]).
See this image and copyright information in PMC

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