Urgent endoscopic drainage for acute suppurative cholangitis due to choledocholithiasis

ABSTRACT

Sixty-four patients with acute suppurative cholangitis due to choledocholithiasis, who did not respond to conservative management, underwent urgent endoscopic drainage of the biliary system at a mean of 1.5 days after admission. Treatment was successful in 54 patients [85%]. They were classified into four groups. Group 1 included 33 patients for whom adequate sphincterotomy and nasobiliary drainage were done. Group 2 included 12 patients with coexisting coagulopathies for whom small papillotomy [<0.5 cm] and nasobiliary catheter drainage were performed. Group 3 included 7 patients, properly selected, for whom adequate sphincterotomy and stone extraction were done in the same session. Group 4 included 2 patients underwent drainage and stone extraction via a previous choledochoduodenostomy. Post-sphincterotomy bleeding was seen in 4 cases [7.5%]. The bleeding was controlled either by local adrenaline injection 1/10.000 [in 3 cases] or by heat probe thermocoagulation [in one case]. Seven patients died, 5 of them were among those underwent endoscopic drainage [9.2%]. Three cases were in group 2 and 2 cases were in group 1. The cause of death was uncontrollable sepsis despite adequate drainage. In conclusion, urgent endoscopic drainage could be used successfully to control biliary sepsis and should be offered to all patients with acute suppurative cholangitis