ENDOSCOPIC MANAGEMENT OF CHOLANGITIS - CRITICAL-REVIEW OF AN ALTERNATIVE TECHNIQUE AND REPORT OF A LARGE SERIES

Objective: To assess the outcome of endoscopic techniques as the solit ary treatment modality for the complete management of ascending, bacte rial cholangitis, compared with results of radiological and surgical m ethods as historical controls. Methods: Endoscopic techniques were use d to decompress bile ducts obstructed by stones (898 patients) or sten osis (49 patients). Endoscopic sphincterotomy (ES) was performed in 83 9 patients, and either 7-Fr straight stents (79), or nasobiliary tubes (29), were utilized as initial therapy in 108 patients. Of these latt er patients, 68 subsequently underwent ES and stone removal, 17 had ES , lithotripsy, and stone removal, 18 were left with stents in place, a nd 5 were lost to follow-up. Follow-up was conducted by direct patient contact, by telephone, or through the referring physicians. Results: All patients were managed by endoscopic techniques. There were four de aths (0.42%) in the first 30 days (none before 2 wk); no deaths were r elated to the procedures but were attributed to intercurrent medical p roblems. Two patients underwent surgery: one pancreatitis, one perfora tion. Complications were infrequent, occurring in 6% of patients. Blee ding occurred in 3%, pancreatitis in 2.8%, and perforation 0.2%. Concl usions: Endoscopic management of cholangitis is as effective as surgic al or radiological methods for managing bacterial cholangitis, a poten tially fatal syndrome, but ERCP and ES have been shown to be safer. En doscopy is the preferred index technique both for establishing a defin itive diagnosis and providing therapy.