ASGE guideline on the management of cholangitis

James L. Buxbaum, Carlos Buitrago, Alice Lee, Badih Joseph Elmunzer, Ahsun Riaz, Eugene P. Ceppa, Mohammed Al-Haddad, Stuart K. Amateau, Audrey H. Calderwood, Douglas S. Fishman, Larissa L. Fujii-Lau, Laith H. Jamil, Terry L. Jue, Richard S. Kwon, Joanna K. Law, Jeffrey K. Lee, Mariam Naveed, Swati Pawa, Mandeep S. Sawhney, Hannah SchilperoortAndrew C. Storm, Nirav C. Thosani, Bashar J. Qumseya, Sachin Wani

Research output: Contribution to journalArticlepeer-review

Abstract

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 vs >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.

Original languageEnglish (US)
Pages (from-to)207-221.e14
JournalGastrointestinal endoscopy
Volume94
Issue number2
DOIs
StatePublished - Aug 1 2021

Bibliographical note

Funding Information:
The following authors disclosed financial relationships: J. Buxbaum is a consultant for Boston Scientific Corporation, Eagle Pharmaceuticals, Inc, Cook Medical LLC, and Olympus America Inc; and receives grant support from Medtronic USA, Inc and Olympus America Inc. C. Buitrago disclosed no financial relationships. A. Lee disclosed no financial relationships. B. Elmunzer is a consultant for Takeda Pharmaceuticals. A. Riaz disclosed no financial relationships. E. Ceppa disclosed no financial relationships . M. Al-Haddad has received research and teaching support from Boston Scientific Corporation. S. Amateau is a consultant for Boston Scientific Corporation, Cook Medical LLC, Endo-Therapeutics, Hemostasis LLC, Merit Medical Systems Inc, Olympus Corporation of the Americas, and STERIS Corporation. A. Calderwood disclosed no financial relationships. D. Fishman disclosed no financial relationships. L. Fujii-Lau has received travel compensation from Ovesco. L. Jamil disclosed no financial relationships. T. Jue disclosed no financial relationships. R. Kwon disclosed no financial relationships. J. Law disclosed no financial relationships. J. Lee disclosed no financial relationships. M. Naveed disclosed no financial relationships. S. Pawa disclosed no financial relationships. M. Sawhney is a stock holder with Allurion Technology, Inc, H. Schilperoort disclosed no financial relationships. A. Storm is a consultant for Apollo Endo Surgery, Endo-TAGSS, and Enterasense; data and safety monitoring from ERBE USA Inc and GI Dynamics; and receives research support from Boston Scientific. N. Thosani is a consultant for Boston Scientific Coporation, TaeWoong Medical, is a consultant and receives research support from PENTAX of America, Inc, receives royalties from UpToDate, receives research support from Endogastric Solutions, is a speaker for Abbie, and is on the advisory board for ColubrisMX Inc. B. Qumseya disclosed no financial relationships. S. Wani is a consultant for Boston Scientific Corporation, Medtronic, Exact Sciences and Interpace, and is on the advisory board for Cernostics.

Funding Information:
The authors are grateful to Patricia Maxin from the Cholangiocarcinoma Foundation for her input as a patient advocate on this guideline panel. This guideline was funded exclusively by the American Society for Gastrointestinal Endoscopy; no outside funding was received to support the development of this guideline.

Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy

PubMed: MeSH publication types

  • Practice Guideline

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