Diagnostic and Therapeutic Value of ERCP in Acute Cholangitis

Cholangitis, with a clinical spectrum between acute ascending cholangitis and acute fulminant cholangitis, the mildest and the most severe forms, respectively, is the infection of bile ducts with a potential of serious mortality and morbidity. Obstruction of the bile ducts followed by infection, with E. coli being the most commonly isolated agent, is common to all forms of cholangitis. Biliary obstruction is caused by choledocholithiasis mostly. “Choledochal pressure” is the most important factor, determining morbidity. If the pressure exceeds 25？cm H2O, which is the critical value, immune dysfunction ensues. Sepsis is common if the infection of biliary ducts is suppurative. Mortality and morbidity are inevitable if left untreated or drained late. The objective of this study is, in the stand point of the current literature, to analyse the diagnostic, therapeutic success and complication rates of ERCP (Endoscopic retrograde cholangiopancreatography) in patients with a diagnosis of acute purulent cholangitis with no response to medical treatment. 1. Introduction Inflammation of the biliary ducts is called cholangitis. Inflammatory process usually begins extrahepatically and easily spreads intrahepatically, causing bacteriemia. Cholangitis was first defined by Charcot in 1877. Obstruction of the biliary ducts and presence of a superposing bacterial infection are common features in cholangitis. The mildest clinical form is ascending cholangitis, and the most severe form is acute fulminant cholangitis. Not every biliary obstruction is associated with cholangitis but there is surely a biliary obstruction in every cholangitis case [1–4]. “Reynolds pentad” was defined with the addition of mental confusion and septic shock, in 1959, by Reynolds and Dragon, to the clinical findings known as “Charcot triad” (fever, abdominal pain, and jaundice) [5, 6]. Biliary obstruction is caused by choledocholithiasis mostly. Moreover, malignancy, benign strictures, and interventions to the biliary ducts may be the cause of biliary obstruction. Bacterial contamination of the biliary ducts may be caused by ascending infection or portal bacteriemia. That means cholangitis clinically. “Choledochal pressure” is the most important factor, determining morbidity. If the pressure exceeds 25？cm H2O, which is the critical value, hepatic defence mechanisms against infection are disrupted and immune dysfunction ensues. Obstruction of the biliary ducts, increased intraluminal pressure, and infected bile are important in the pathogenesis of cholangitis. In 25–40% of the cases, associated