EMERGENCY APPROACH AND BILIARY DECOMPRESSION IN THE TREATMENT OF ACUTE CHOLANGITIS

Abstract

Cholangitis, although often presenting a chronic course, poses critical challenges in scenarios of acute exacerbation and severe biliary obstruction. This narrative literature review aimed to consolidate contemporary scientific evidence on emergency management and biliary decompression strategies, with the goal of preserving hepatic function and reducing morbidity and mortality. The methodology consisted of data retrieval from the PubMed database (MeSH terms: "Cholangitis" and "Therapeutics"), focusing on high methodological rigor studies published within the last five years. The findings demonstrate that therapeutic effectiveness is intrinsically linked to the accuracy of differential diagnosis among the various etiologies. In Primary Biliary Cholangitis (PBC), the use of ursodeoxycholic acid (UDCA) remains the gold standard for slowing disease progression. On the other hand, IgG4-Related Cholangitis (IgG4-SC) requires diagnostic caution due to its ability to mimic neoplasms, showing a dramatic response to corticosteroid therapy and avoiding unnecessary surgical interventions. In Primary Sclerosing Cholangitis (PSC), given the absence of curative pharmacological therapies, mechanical decompression via endoscopic approach (ERCP) plays a central role in managing dominant strictures and preventing recurrent infectious episodes. Ultimately, hemodynamic stabilization and prompt biliary decompression constitute the absolute priorities in the treatment of acute cholangitis to prevent biliary sepsis. It is concluded that patient prognosis depends directly on a multidisciplinary approach that integrates early recognition of complications, intensive clinical support, and the individualization of maintenance strategies according to the immunopathological profile of each condition.