Methods and timing of biliary drainage for acute cholangitis: Tokyo Guidelines

Masato Nagino, Tadahiro Takada, Yoshifumi Kawarada, Yuji Nimura, Yuichi Yamashita, Toshio Tsuyuguchi, Keita Wada, Toshihiko Mayumi, Masahiro Yoshida, Fumihiko Miura, Steven M. Strasberg, Henry A. Pitt, Jacques Belghiti, Sheung Tat Fan, Kui Hin Liau, Giulio Belli, Xiao Ping Chen, Edward Cheuck Seen Lai, Benny P. Philippi, Harjit SinghAvinash Supe

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Biliary drainage is a radical method to relieve cholestasis, a cause of acute cholangitis, and takes a central part in the treatment of acute cholangitis. Emergent drainage is essential for severe cases, whereas patients with moderate and mild disease should also receive drainage as soon as possible if they do not respond to conservative treatment, and their condition has not improved. Biliary drainage can be achieved via three different routes/procedures: endoscopic, percutaneous transhepatic, and open methods. The clinical value of both endoscopic and percutaneous transhepatic drainage is well known. Endoscopic drainage is associated with a low morbidity rate and shorter duration of hospitalization; therefore, this approach is advocated whenever it is applicable. In endoscopic drainage, either endoscopic nasobiliary drainage (ENBD) or tube stent placement can be used. There is no significant difference in the success rate, effectiveness, and morbidity between the two procedures. The decision to perform endoscopic sphincterotomy (EST) is made based on the patient's condition and the number and diameter of common bile duct stones. Open drainage, on the other hand, should be applied only in patients for whom endoscopic or percutaneous transhepatic drainage is contraindicated or has not been successfully performed. Cholecystectomy is recommended in patients with gallbladder stones, following the resolution of acute cholangitis with medical treatment, unless the patient has poor operative risk factors or declines surgery.

Original languageEnglish (US)
Pages (from-to)68-77
Number of pages10
JournalJournal of Hepato-Biliary-Pancreatic Surgery
Issue number1
StatePublished - Jan 2007
Externally publishedYes


  • Biliary
  • Cholangitis
  • Drainage
  • Endoscopy
  • Guidelines
  • Percutaneous
  • Sphincterotomy

ASJC Scopus subject areas

  • Surgery
  • Hepatology


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