Contemporary treatment methods in acute cholangitis

Abstract

Introduction. Acute cholangitis is a medical emergency and is a potential life-threatening condition, is an infectious process of the entire biliary tree or only of the intrahepatic system developed almost always under the conditions of partial or complete obstruction of the main biliary tract.. If this condition is not treated with antibiotic therapy and the earlier decline of bile pressure, the risk of aggravation of the situation and mortality increases. The actuality of the problem is determined by the increase of the number of diseases of the organs in the hepatopancreatoduodenal area, which are accompanied by a lot of complications. Aim of the study. Research of surgical tactical opportunities in acute cholangitis. Materials and methods. Scientific articles were searched in PubMed, Hinari and Cambridge University press databases, using the descriptors "acute cholangitis", "biliary stenting", "nasobiliary drainage". The research was not delimited to a specific time period and was supplemented with bibliographic data from statistical sites, from Ministry of Health, Labor and Social Protection of Moldova. Results. Reaching positive results in the treatment of cholangitis, is possible by performing the diagnostic and therapeutic maneuvers in stages. A necessary condition is the strict observance of the sequences and the time in each stage by the maximum use of the endosurgical and miniinvasive interventions. Early surgery in acute cholangitis is accompanied by an increased frequency of complications. Advances in therapeutic endoscopy, such as balloon drainage guided by balloon enteroscopy or endoscopic ultrasound-guided biliary drainage, have added new extent for the endoscopic management of acute cholangitis, which avoids the need for more invasive procedures. Bile drainage can be achieved by different methods and procedures: endoscopic, percutaneous and open transhepatic. Endoscopic drainage is associated with a shorter duration of hospitalization and a low morbidity rate. Conclusions. The treatment tactic in acute cholangitis remains a current problem in hepatobiliary surgery. So far, there are many questions for pathogenesis, diagnosis, treatment and prevention, which need to be solved. Acute cholangitis requires an in-depth multidisciplinary study, which allows the adoption of a correct management for each clinical case, and the application of the stepped treatment tactic will allow us to obtain positive results in this pathology.