BILIARY-TRACT EMERGENCIES - ENDOSCOPIC AND MEDICAL-MANAGEMENT

Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has assumed an increasing and essential role in the diagnosis and treatment of biliary tract emergencies. Although cholecystectomy remains the principal treatment far acute cholecystitis, both calculous and acalculous, endoscopic and radiologic drainage procedures can be used in patients at high risk for surgery. Urgent endoscopic biliary drainage is life saving in patients with refractory cholangitis. It is as effective as surgical decompression but with significantly lower morbidity and mortality. In patients with gallstone pancreatitis, urgent endoscopic sphincterotomy and common duct stone extraction are superior to conventional medical management or early surgical intervention. ERCP is crucial in diagnosing and treating the increased incidence of bile duct leaks and injuries following laparoscopic cholecystectomy.