Comparison of endoscopic and surgical treatment for acute cholangitis caused by choledocolithiasis

Background: Endoscopic drainage of the biliary tree for acute cholangitis i s a therapeutic modality with a lower mortality and complication rates. Aim : To compare endoscopic drainage with surgical treatment in the emergency m anagement of acute cholangitis. Patients and methods: Between 1995 and 1998 , sixty five patients with acute cholangitis were subjected to an endoscopi c drainage of the biliary tree. In the same period 40 patients were treated with traditional surgical procedures. The evolution of both groups of pati ents were compared. Results: Sixty two patients (95.4%) subjected to endosc opic treatment bad a satisfactory evolution, compared with 23 (58%) of thos e operated (p <0.001). Five operated patients and no individual subjected t o endoscopic drainage died (p <0.01). Mean postoperative hospital stay of o perated patients was 15.5 +/- 19.6 days compared to 5.8 +/- 4.2 days in tho se subjected to endoscopic drainage (p <0.001). Definitive resolution of bi liary obstruction was achieved in 83% of patients subjected to endoscopic d rainage or traditional surgery. Conclusions: Endoscopic drainage has a lowe r rate of complications and mortality than traditional surgery, in the trea tment of acute cholangitis. (Rev Med Chile 2001; 753-62).