Current management of recurrent pyogenic cholangitis

Recurrent pyogenic cholangitis (RPC) is a chronic disease with multiple exa cerbations requiring repeated biliary dilatation and stone removal. Even af ter adequate biliary drainage, most patients will have progression of intra hepatic disease. Management of patients with RPC is a multidisciplinary cha llenge for endoscopists, interventional radiologists, and surgeons because of the frequency and inaccessibility of strictures and stones. Complete sto ne clearance at any one operation is difficult. Hepaticojejunostomy with a subcutaneous afferent limb is a safe and effective way to provide access to the biliary tree for the management of patients with RPC. In our experienc e, trans-stomal cholangioscopic stricture dilatation followed by stone remo val remains the basis of therapy in patients with RPC. By diligent surveill ance, we should be able to eliminate or decrease the number of stones and p revent cholangitis and its sequelae.