What is included in emergency department (ED) medical therapy for acute cholangitis?

Updated: Dec 29, 2017
  • Author: Timothy M Scott, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Medical therapy can be complementary to surgical or endoscopic treatments. In less ill patients, medical treatment may be all that is necessary. Perform the following:

  • Maintain medical therapy and consider elective surgery with patients who show improvement. Patients who are being medically managed and do not improve or who deteriorate should rapidly be referred to undergo either endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, or percutaneous drainage. [14] See the management algorithm below.

    Algorithm for management of patients with acute ch Algorithm for management of patients with acute cholangitis.
  • The mainstay of therapy is drainage. ERCP is the best method to accomplish biliary drainage. A study by Sharma showed equal safety and effectiveness when using a 7 Fr stent or 10 Fr stent for biliary drainage in patients with severe cholangitis. [19]


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