In acute cholangitis, which procedure helps decompress the biliary tree?

In acute cholangitis, which procedure helps decompress the biliary tree?

• A. ERCP with sphincterotomy
• B. Laparoscopic cholecystectomy
• C. Percutaneous biliary drainage
• D. Endoscopic stenting without sphincterotomy

Answer: (A)

Relieving the blockage in the biliary system is the immediate priority in acute cholangitis, because ongoing obstruction drives infection and sepsis. The most effective way to achieve rapid decompression is through endoscopic drainage of the biliary tree. Endoscopic retrograde cholangiopancreatography with sphincterotomy allows direct access to the common bile duct, enabling removal of stones or debris and, if needed, placement of a biliary stent. This creates a ready outflow path for bile, lowers ductal pressure, and rapidly improves drainage and infection control, which is why it’s the preferred method in this scenario. Surgery to remove the gallbladder or perform cholecystectomy isn’t the immediate step for decompression in acute cholangitis; it addresses gallbladder disease but doesn’t relieve the acute obstruction promptly. Percutaneous biliary drainage can be used if ERCP isn’t possible or has failed, but ERCP with sphincterotomy is the standard first-line decompression. Stenting without sphincterotomy isn’t the typical approach because efficient access and drainage of the duct usually require sphincterotomy.

Relieving the blockage in the biliary system is the immediate priority in acute cholangitis, because ongoing obstruction drives infection and sepsis. The most effective way to achieve rapid decompression is through endoscopic drainage of the biliary tree. Endoscopic retrograde cholangiopancreatography with sphincterotomy allows direct access to the common bile duct, enabling removal of stones or debris and, if needed, placement of a biliary stent. This creates a ready outflow path for bile, lowers ductal pressure, and rapidly improves drainage and infection control, which is why it’s the preferred method in this scenario.

Surgery to remove the gallbladder or perform cholecystectomy isn’t the immediate step for decompression in acute cholangitis; it addresses gallbladder disease but doesn’t relieve the acute obstruction promptly. Percutaneous biliary drainage can be used if ERCP isn’t possible or has failed, but ERCP with sphincterotomy is the standard first-line decompression. Stenting without sphincterotomy isn’t the typical approach because efficient access and drainage of the duct usually require sphincterotomy.