Gastroenterology and hepatology
Biliary obstruction and cholangitis
Benign and malignant bile duct obstruction, risk-stratifying suspected duct stones (ASGE 2019), Tokyo 2018 diagnosis and grading of cholangitis, antibiotics and drainage timing, stent choice, and the complications of ERCP.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Obstruction of bile flow causes cholestatic LFTs (ALP and GGT rise, then conjugated bilirubin) and, once the duct is infected, acute cholangitis.
- Stones are the commonest benign cause. Pancreatic head cancer and cholangiocarcinoma are the commonest malignant causes.
- Cholangitis kills through sepsis. The treatment is antibiotics plus drainage, timed by Tokyo 2018 severity grade, and ERCP is the drainage of choice.
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Sources
- Therapeutic Guidelines: Gastrointestinal and Antibiotic (eTG complete), acute cholangitis and biliary tract infectionsAU/NZTherapeutic Guidelines Limited
- Kiriyama S et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis. J Hepatobiliary Pancreat Sci 2018;25:17-30Japanese Society of Hepato-Biliary-Pancreatic Surgery, 2018
- Buxbaum JL et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 2019;89:1075-1105American Society for Gastrointestinal Endoscopy, 2019
- Buxbaum JL et al. ASGE guideline on the management of cholangitis. Gastrointest Endosc 2021;94:207-221American Society for Gastrointestinal Endoscopy, 2021
- Manes G et al. Endoscopic management of common bile duct stones: ESGE guideline. Endoscopy 2019;51:472-491European Society of Gastrointestinal Endoscopy, 2019
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy