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Semin intervent Radiol 2021; 38(03): 321-329
DOI: 10.1055/s-0041-1731370
Review Article

Role of Interventional Radiology in the Management of Acute Cholangitis

Pouya Entezari
1   Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
,
Jonathan A. Aguiar
1   Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
,
Riad Salem
1   Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
,
Ahsun Riaz
1   Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Abstract

Acute cholangitis presents with a wide severity spectrum and can rapidly deteriorate from local infection to multiorgan failure and fatal sepsis. The pathophysiology, diagnosis, and general management principles will be discussed in this review article. The focus of this article will be on the role of biliary drainage performed by interventional radiology to manage acute cholangitis. There are specific scenarios where percutaneous drainage should be preferred over endoscopic drainage. Percutaneous transhepatic and transjejunal biliary drainage are both options available to interventional radiology. Additionally, interventional radiology is now able to manage these patients beyond providing acute biliary drainage including cholangioplasty, stenting, and percutaneous cholangioscopy/biopsy.

Keywords

acute cholangitis - percutaneous transhepatic cholangiography - biliary drainage


Publication History

Article published online:
10 August 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Kiriyama S, Takada T, Strasberg SM. et al; Tokyo Guidelines Revision Committee. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci 2012; 19 (05) 548-556
    CrossrefPubMedGoogle Scholar
  • 2 Wada K, Takada T, Kawarada Y. et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14 (01) 52-58
    CrossrefPubMedGoogle Scholar
  • 3 Nagino M, Takada T, Kawarada Y. et al. Methods and timing of biliary drainage for acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14 (01) 68-77
    CrossrefPubMedGoogle Scholar
  • 4 Kiriyama S, Takada T, Strasberg SM. et al; Tokyo Guidelines Revision Committee. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013; 20 (01) 24-34
    CrossrefPubMedGoogle Scholar
  • 5 Khashab MA, Tariq A, Tariq U. et al. Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis. Clin Gastroenterol Hepatol 2012; 10 (10) 1157-1161
    CrossrefPubMedGoogle Scholar
  • 6 Park CS, Jeong HS, Kim KB. et al. Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients. Hepatobiliary Pancreat Dis Int 2016; 15 (06) 619-625
    CrossrefPubMedGoogle Scholar
  • 7 Kimura Y, Takada T, Kawarada Y. et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14 (01) 15-26
    CrossrefPubMedGoogle Scholar
  • 8 Sokal A, Sauvanet A, Fantin B, de Lastours V. Acute cholangitis: diagnosis and management. J Visc Surg 2019; 156 (06) 515-525
    CrossrefPubMedGoogle Scholar
  • 9 Gigot JF, Leese T, Dereme T, Coutinho J, Castaing D, Bismuth H. Acute cholangitis. Multivariate analysis of risk factors. Ann Surg 1989; 209 (04) 435-438
    CrossrefPubMedGoogle Scholar
  • 10 Gomi H, Solomkin JS, Takada T. et al; Tokyo Guideline Revision Committee. TG13 antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20 (01) 60-70
    CrossrefPubMedGoogle Scholar
  • 11 Miura F, Okamoto K, Takada T. et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 2018; 25 (01) 31-40
    CrossrefPubMedGoogle Scholar
  • 12 Welch JP, Donaldson GA. The urgency of diagnosis and surgical treatment of acute suppurative cholangitis. Am J Surg 1976; 131 (05) 527-532
    CrossrefPubMedGoogle Scholar
  • 13 Boey JH, Way LW. Acute cholangitis. Ann Surg 1980; 191 (03) 264-270
    CrossrefPubMedGoogle Scholar
  • 14 Kiriyama S, Takada T, Hwang TL. 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 (06) 329-337
    CrossrefPubMedGoogle Scholar
  • 15 Kiriyama S, Kozaka K, Takada T. et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25 (01) 17-30
    CrossrefPubMedGoogle Scholar
  • 16 Sulzer JK, Ocuin LM. Cholangitis: causes, diagnosis, and management. Surg Clin North Am 2019; 99 (02) 175-184
    CrossrefPubMedGoogle Scholar
  • 17 Watanapa P. Recovery patterns of liver function after complete and partial surgical biliary decompression. Am J Surg 1996; 171 (02) 230-234
    CrossrefPubMedGoogle Scholar
  • 18 Umefune G, Kogure H, Hamada T. et al. Procalcitonin is a useful biomarker to predict severe acute cholangitis: a single-center prospective study. J Gastroenterol 2017; 52 (06) 734-745
    CrossrefPubMedGoogle Scholar
  • 19 Shinya S, Sasaki T, Yamashita Y. et al. Procalcitonin as a useful biomarker for determining the need to perform emergency biliary drainage in cases of acute cholangitis. J Hepatobiliary Pancreat Sci 2014; 21 (10) 777-785
    CrossrefPubMedGoogle Scholar
  • 20 Solomkin JS, Mazuski JE, Bradley JS. et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt) 2010; 11 (01) 79-109
    CrossrefPubMedGoogle Scholar
  • 21 Kelly AM. Clinical impact of blood cultures taken in the emergency department. J Accid Emerg Med 1998; 15 (04) 254-256
    CrossrefPubMedGoogle Scholar
  • 22 Catalano OA, Sahani DV, Forcione DG. et al. Biliary infections: spectrum of imaging findings and management. Radiographics 2009; 29 (07) 2059-2080
    CrossrefPubMedGoogle Scholar
  • 23 Rickes S, Treiber G, Mönkemüller K. et al. Impact of the operator's experience on value of high-resolution transabdominal ultrasound in the diagnosis of choledocholithiasis: a prospective comparison using endoscopic retrograde cholangiography as the gold standard. Scand J Gastroenterol 2006; 41 (07) 838-843
    CrossrefPubMedGoogle Scholar
  • 24 Einstein DM, Lapin SA, Ralls PW, Halls JM. The insensitivity of sonography in the detection of choledocholithiasis. AJR Am J Roentgenol 1984; 142 (04) 725-728
    CrossrefPubMedGoogle Scholar
  • 25 Abboud P-AC, Malet PF, Berlin JA. et al. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastrointest Endosc 1996; 44 (04) 450-455
    CrossrefPubMedGoogle Scholar
  • 26 Lee JK, Kim TK, Byun JH. et al. Diagnosis of intrahepatic and common duct stones: combined unenhanced and contrast-enhanced helical CT in 1090 patients. Abdom Imaging 2006; 31 (04) 425-432
    CrossrefPubMedGoogle Scholar
  • 27 de Lédinghen V, Lecesne R, Raymond J-M. et al. Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study. Gastrointest Endosc 1999; 49 (01) 26-31
    CrossrefPubMedGoogle Scholar
  • 28 Buyukasik K, Toros AB, Bektas H, Ari A, Deniz MM. Diagnostic and therapeutic value of ERCP in acute cholangitis. ISRN Gastroenterol 2013; 2013: 191729
    CrossrefPubMedGoogle Scholar
  • 29 Kinney TP. Management of ascending cholangitis. Gastrointest Endosc Clin N Am 2007; 17 (02) 289-306 , vi
    CrossrefPubMedGoogle Scholar
  • 30 Westphal JF, Brogard JM. Biliary tract infections: a guide to drug treatment. Drugs 1999; 57 (01) 81-91
    CrossrefPubMedGoogle Scholar
  • 31 Lan Cheong Wah D, Christophi C, Muralidharan V. Acute cholangitis: current concepts. ANZ J Surg 2017; 87 (7-8): 554-559
    CrossrefPubMedGoogle Scholar
  • 32 Sung JJ, Lyon DJ, Suen R. et al. Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial. J Antimicrob Chemother 1995; 35 (06) 855-864
    CrossrefPubMedGoogle Scholar
  • 33 Ahmed M. Acute cholangitis - an update. World J Gastrointest Pathophysiol 2018; 9 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 34 Gomi H, Solomkin JS, Schlossberg D. et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2018; 25 (01) 3-16
    CrossrefPubMedGoogle Scholar
  • 35 Mukai S, Itoi T, Baron TH. et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci 2017; 24 (10) 537-549
    CrossrefPubMedGoogle Scholar
  • 36 Hamlin JA, Friedman M, Stein MG, Bray JF. Percutaneous biliary drainage: complications of 118 consecutive catheterizations. Radiology 1986; 158 (01) 199-202
    CrossrefPubMedGoogle Scholar
  • 37 Mueller PR, van Sonnenberg E, Ferrucci Jr JT. Percutaneous biliary drainage: technical and catheter-related problems in 200 procedures. AJR Am J Roentgenol 1982; 138 (01) 17-23
    CrossrefPubMedGoogle Scholar
  • 38 Takada T, Hanyu F, Kobayashi S, Uchida Y. Percutaneous transhepatic cholangial drainage: direct approach under fluoroscopic control. J Surg Oncol 1976; 8 (01) 83-97
    CrossrefPubMedGoogle Scholar
  • 39 Weber A, Gaa J, Rosca B. et al. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol 2009; 72 (03) 412-417
    CrossrefPubMedGoogle Scholar
  • 40 Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 2010; 21 (06) 789-795
    CrossrefPubMedGoogle Scholar
  • 41 Yusoff IF, Barkun JS, Barkun AN. Diagnosis and management of cholecystitis and cholangitis. Gastroenterol Clin North Am 2003; 32 (04) 1145-1168
    CrossrefPubMedGoogle Scholar
  • 42 Yeh YH, Huang MH, Yang JC, Mo LR, Lin J, Yueh SK. Percutaneous trans-hepatic cholangioscopy and lithotripsy in the treatment of intrahepatic stones: a study with 5 year follow-up. Gastrointest Endosc 1995; 42 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 43 McNabb-Baltar J, Trinh QD, Barkun AN. Biliary drainage method and temporal trends in patients admitted with cholangitis: a national audit. Can J Gastroenterol 2013; 27 (09) 513-518
    CrossrefPubMedGoogle Scholar
  • 44 Covey AM, Brown KT. Percutaneous transhepatic biliary drainage. Tech Vasc Interv Radiol 2008; 11 (01) 14-20
    CrossrefPubMedGoogle Scholar
  • 45 Riaz A, Pinkard JP, Salem R, Lewandowski RJ. Percutaneous management of malignant biliary disease. J Surg Oncol 2019; 120 (01) 45-56
    CrossrefPubMedGoogle Scholar
  • 46 Takada T, Yasuda H, Hanyu F. Technique and management of percutaneous transhepatic cholangial drainage for treating an obstructive jaundice. Hepatogastroenterology 1995; 42 (04) 317-322
    PubMedGoogle Scholar
  • 47 Tsuyuguchi T, Takada T, Kawarada Y. et al. Techniques of biliary drainage for acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14 (01) 35-45
    CrossrefPubMedGoogle Scholar
  • 48 Perez-Johnston R, Deipolyi AR, Covey AM. Percutaneous biliary interventions. Gastroenterol Clin North Am 2018; 47 (03) 621-641
    CrossrefPubMedGoogle Scholar
  • 49 Yadav A, Condati NK, Mukund A. Percutaneous transhepatic biliary interventions. J Clin Interv Radiol ISVIR 2018; 2 (01) 27-37
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Hutson DG, Russell E, Schiff E, Levi JJ, Jeffers L, Zeppa R. Balloon dilatation of biliary strictures through a choledochojejuno-cutaneous fistula. Ann Surg 1984; 199 (06) 637-647
    CrossrefPubMedGoogle Scholar
  • 51 Russell E, Yrizarry JM, Huber JS. et al. Percutaneous transjejunal biliary dilatation: alternate management for benign strictures. Radiology 1986; 159 (01) 209-214
    CrossrefPubMedGoogle Scholar
  • 52 McPherson SJ, Gibson RN, Collier NA, Speer TG, Sherson ND. Percutaneous transjejunal biliary intervention: 10-year experience with access via Roux-en-Y loops. Radiology 1998; 206 (03) 665-672
    CrossrefPubMedGoogle Scholar
  • 53 Kim D, Bolus C, Iqbal SI. et al. Percutaneous transjejunal biliary access in 60 patients with bilioenteric anastomoses. J Vasc Interv Radiol 2019; 30 (01) 76-81.e1
    CrossrefPubMedGoogle Scholar
  • 54 Riaz A, Entezari P, Ganger D. et al. Percutaneous access of the modified Hutson loop for retrograde cholangiography, endoscopy, and biliary interventions. J Vasc Interv Radiol 2020; 31 (12) 2113-2120.e1
    CrossrefPubMedGoogle Scholar
  • 55 Sugiyama M, Atomi Y. Treatment of acute cholangitis due to choledocholithiasis in elderly and younger patients. Arch Surg 1997; 132 (10) 1129-1133
    CrossrefPubMedGoogle Scholar
  • 56 Lai EC, Tam PC, Paterson IA. et al. Emergency surgery for severe acute cholangitis. The high-risk patients. Ann Surg 1990; 211 (01) 55-59
    CrossrefPubMedGoogle Scholar
  • 57 Huang MH, Ker CG. Ultrasonic guided percutaneous transhepatic bile drainage for cholangitis due to intrahepatic stones. Arch Surg 1988; 123 (01) 106-109
    CrossrefPubMedGoogle Scholar
  • 58 Sugiyama M, Atomi Y. The benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis. Am J Gastroenterol 1998; 93 (11) 2065-2068
    CrossrefPubMedGoogle Scholar
  • 59 Al Mahjoub A, Menahem B, Fohlen A. et al. Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: Is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J Vasc Interv Radiol 2017; 28 (04) 576-582
    CrossrefPubMedGoogle Scholar
  • 60 Duan F, Cui L, Bai Y, Li X, Yan J, Liu X. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging 2017; 17 (01) 27
    CrossrefPubMedGoogle Scholar
  • 61 Sharaiha RZ, Khan MA, Kamal F. et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85 (05) 904-914
    CrossrefPubMedGoogle Scholar
  • 62 Baniya R, Upadhaya S, Madala S, Subedi SC, Shaik Mohammed T, Bachuwa G. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis. Clin Exp Gastroenterol 2017; 10: 67-74
    CrossrefPubMedGoogle Scholar
  • 63 Nam K, Kim DU, Lee TH. et al. Patient perception and preference of EUS-guided drainage over percutaneous drainage when endoscopic transpapillary biliary drainage fails: an international multicenter survey. Endosc Ultrasound 2018; 7 (01) 48-55
    CrossrefPubMedGoogle Scholar
  • 64 Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E. et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 2012; 76 (06) 1133-1141
    CrossrefPubMedGoogle Scholar
  • 65 Nennstiel S, Weber A, Frick G. et al. Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. J Clin Gastroenterol 2015; 49 (09) 764-770
    CrossrefPubMedGoogle Scholar
  • 66 Yee AC, Ho CS. Complications of percutaneous biliary drainage: benign vs malignant diseases. AJR Am J Roentgenol 1987; 148 (06) 1207-1209
    CrossrefPubMedGoogle Scholar
  • 67 Lucatelli P, Corradini SG, Corona M. et al. Risk factors for immediate and delayed-onset fever after percutaneous transhepatic biliary drainage. Cardiovasc Intervent Radiol 2016; 39 (05) 746-755
    CrossrefPubMedGoogle Scholar
  • 68 Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA. Comparison of infection between internal-external and external percutaneous transhepatic biliary drainage in treating patients with malignant obstructive jaundice. Asian Pac J Cancer Prev 2015; 16 (06) 2543-2546
    CrossrefPubMedGoogle Scholar
  • 69 Patel V, McLaughlin SW, Shlansky-Goldberg R. et al. Complication rates of percutaneous biliary drainage in the presence of ascites. Abdom Radiol (NY) 2019; 44 (05) 1901-1906
    CrossrefPubMedGoogle Scholar
  • 70 Choi SH, Gwon DI, Ko GY. et al. Hepatic arterial injuries in 3110 patients following percutaneous transhepatic biliary drainage. Radiology 2011; 261 (03) 969-975
    CrossrefPubMedGoogle Scholar
  • 71 Hamada T, Yasunaga H, Nakai Y. et al. Severe bleeding after percutaneous transhepatic drainage of the biliary system: effect of antithrombotic agents--analysis of 34 606 cases from a Japanese nationwide administrative database. Radiology 2015; 274 (02) 605-613
    CrossrefPubMedGoogle Scholar
  • 72 Saad WE, Davies MG, Darcy MD. Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech Vasc Interv Radiol 2008; 11 (01) 60-71
    CrossrefPubMedGoogle Scholar
  • 73 Sharaiha RZ, Kumta NA, Desai AP. et al. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc 2016; 30 (12) 5500-5505
    CrossrefPubMedGoogle Scholar
  • 74 Khashab MA, Valeshabad AK, Afghani E. et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci 2015; 60 (02) 557-565
    CrossrefPubMedGoogle Scholar
  • 75 Bapaye A, Dubale N, Aher A. Comparison of endosonography-guided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP. United European Gastroenterol J 2013; 1 (04) 285-293
    CrossrefPubMedGoogle Scholar
  • 76 Lee TH, Choi JH, Park H. et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2016; 14 (07) 1011-1019.e3
    CrossrefPubMedGoogle Scholar
  • 77 Artifon EL, Aparicio D, Paione JB. et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol 2012; 46 (09) 768-774
    CrossrefPubMedGoogle Scholar
  • 78 Bill JG, Darcy M, Fujii-Lau LL. et al. A comparison between endoscopic ultrasound-guided rendezvous and percutaneous biliary drainage after failed ERCP for malignant distal biliary obstruction. Endosc Int Open 2016; 4 (09) E980-E985
    Article in Thieme ConnectPubMedGoogle Scholar
  • 79 Giovannini M, Bories E, Napoleon B, Barthet M, Caillol F, Pesenti C. 855 multicenter randomized Phase II study: percutaneous biliary drainage vs EUS guided biliary drainage: results of the intermediate analysis. Gastrointest Endosc 2015; 81 (05) AB174
    CrossrefPubMedGoogle Scholar
  • 80 Torres-Ruiz MF, De La Mora-Levy JG, Alonso-Larraga JO, Del Monte JS, Hernandez-Guerrero A. Su1337 biliary drainage in malignant obstruction: a comparative study between EUS-guided vs percutaneous drainage in patients with failed ERCP. Gastrointest Endosc 2016; 83 (05) AB356
    CrossrefPubMedGoogle Scholar
  • 81 Sportes A, Camus M, Grabar S. et al. Mo2084 comparative trial of EUS-guided hepatico-gastrostomy and percutaneous transhepatic biliary drainage for malignant obstructive jaundice after failed ERCP. Gastrointest Endosc 2016; 83 (05) AB522-AB3
    CrossrefPubMedGoogle Scholar