ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-Updates in the Role of Endoscopy Management of Cholangitis

Video Transcription

Video Summary

Dr. Larissa Fujilao from the Queens University Medical Group in Honolulu, Hawaii, discussed updates in the role of endoscopy in the management of cholangitis. She presented a case of a seven-year-old female with fever and abdominal pain, explaining the diagnosis and severity assessment criteria for cholangitis. The Tokyo guidelines state that cholangitis requires systemic inflammation, cholestasis, and biliary obstruction. The severity assessment includes evaluating hemodynamics, mentation, and organ dysfunction. The treatment depends on the severity, with mild cholangitis requiring antibiotics and general supportive care, moderate cholangitis requiring biliary drainage, and severe cholangitis requiring urgent biliary drainage. The ASGE guidelines recommend ERCP over percutaneous transhepatic biliary decompression due to reduced length of stay and fewer adverse events. The timing of ERCP should be within 48 hours, with urgent or delayed ERCP considered in certain cases. Endoscopic techniques like biliary sphincterotomy, stone extraction, and stent placement are recommended depending on the individual case. The use of bio-aspirates to tailor antibiotic regimens and the consideration of US-guided biliary drainage in specific situations were also discussed.

Asset Subtitle

Larissa L. Fujii-Lau, MD

Keywords

endoscopy

cholangitis

severity assessment

biliary drainage

ERCP