Diagnosis and Management of Acute Cholangitis

Early biliary drainage and same-admission cholecystectomy remain the core of care for acute cholangitis, but the timing of drainage is still debated.

• Acute cholangitis is most often caused by gallstones; mortality has fallen with antibiotics and biliary decompression.
• Newer bile criteria (inflammation, cholestasis, biliary obstruction) are emerging alongside the Tokyo Guidelines for diagnosis and severity grading.
• Ercp is the usual drainage method for moderate to severe cases, while the optimal timing of drainage is still unclear.

Use Tokyo Guidelines grading to guide drainage in moderate to severe cases, and perform laparoscopic cholecystectomy during the index admission when possible, since it is linked to lower morbidity and mortality than interval surgery.