How Do I Diagnose and Manage Acute Cholangitis?

  • Jessica RileyEmail author
  • KinWah Chew
  • Timothy Jang


Acute cholangitis is a disease characterized by obstruction and infection of the biliary tree. Diagnosis is made by a combination of clinical, laboratory, and imaging criteria set forth by the Tokyo Guidelines. All patients with acute cholangitis require antibiotics, and the majority will require decompression of the biliary tree. This can be accomplished in a variety of ways, though endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice.


Acute cholangitis Endoscopic retrograde cholangiopancreatography Tokyo Guidelines Cholestasis Choledocholithiasis Antibiotics 


  1. 1.
    Kiriyama S, Takada T, Hwang T, Akazawa K, Miura F, Gomi H, et al. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. J Hepatobiliary Pancreat Sci. 2017;24:329–37.CrossRefGoogle Scholar
  2. 2.
    Gomi H, Takada T, Hwang T, Akazawa K, Mori R, Endo I, et al. Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis. J Hepatobiliary Pancreat Sci. 2017;24:310–8.CrossRefGoogle Scholar
  3. 3.
    Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo guidelines. J Hepato-Biliary-Pancreat Surg. 2007;14:52–8.CrossRefGoogle Scholar
  4. 4.
    Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis. J Hepatobiliary Pancreat Sci. 2013;20:24–34.CrossRefGoogle Scholar
  5. 5.
    Miura F, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gouma DJ. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:47–54.CrossRefGoogle Scholar
  6. 6.
    Salek J, Livote E, Sideridis K, Bank S. Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis. J Clin Gastroenterol. 2009;43:171–5.CrossRefGoogle Scholar
  7. 7.
    Rumsey S, Winders J, MacCormick AD. Diagnostic accuracy of Charcot’s triad. ANZ J Surg. 2017;87:232–8.CrossRefGoogle Scholar
  8. 8.
    Lan Cheong Wah D, Christophi C, Muralidharan V. Acute cholangitis: current concepts. ANZ J Surg. 2017;87:554–9.CrossRefGoogle Scholar
  9. 9.
    Fuks D, Cossee C, Regimbeau JM. Antimicrobial therapy in acute calculous cholecystitis. J Visc Surg. 2013;150:3–8.CrossRefGoogle Scholar
  10. 10.
    Sartelli M, VIale P, Koike K, Pea F, Tumietto F, vanGoor H, et al. WSES consensus conference: Guidelines for first-line management of intra-acbdominal infections. World J Emerg Surg. 2011;6:2.CrossRefGoogle Scholar
  11. 11.
    Uno S, Hase R, Kobayashi M, Shiratori T, Nakaji S, Hirata N, et al. Short-course antimicrobial treatment for acute cholangitis with gram-negative bacillary bacteremia. Int J Infect Dis. 2017;55:81–5.CrossRefGoogle Scholar
  12. 12.
    Li V, Yum J, Yeung Y. Optimal timing of elective laparoscopic cholecystectomy after acute cholangitis and subsequent clearance of choledocholithiasis. Am J Surg. 2010;200:483–8.CrossRefGoogle Scholar
  13. 13.
    Mosler P. Diagnosis and management of acute cholangitis. Curr Gastroenterol Rep. 2011;13:166–72.CrossRefGoogle Scholar
  14. 14.
    Tan M, Schaffalitzky de Muckadell O, Laursen S. Association between early ERCP and mortality in patients with acute cholangitis. Gastrointest Endosc. 2018;87(1):185–92.CrossRefGoogle Scholar
  15. 15.
    Hou L, Laine L, Motamedi N, Sahakian A, Lane C, Buxbaum J. Optimal timing of endoscopic retrograde cholangiopancreatography in acute cholangitis. J Clin Gastroenterol. 2017;51:534–8.CrossRefGoogle Scholar
  16. 16.
    Szary NM, Al-Kawas FH. Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (NY). 2013;9:496–504.Google Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.WellSpan York Hospital, Department of Emergency MedicineYorkUSA
  2. 2.Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLATorranceUSA

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