Ascending cholangitis diagnostic study of choice: Difference between revisions
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{{CMG}}; {{AE}} {{AHS}} | {{CMG}}; {{AE}} {{AHS}} | ||
== Overview == | == Overview == | ||
MRCP is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of [[endoscopic retrograde cholangiopancreaticography (ERCP)]]. However, [[Endoscopic retrograde cholangiopancreatography|ERCP]] is the gold standard test in diagnosis of ascending cholangitis and is the test of choice for patients who may need therapeutic drainage | [[MRCP]] is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of [[ERCP|endoscopic retrograde cholangiopancreaticography (ERCP)]]. However, [[Endoscopic retrograde cholangiopancreatography|ERCP]] is the gold standard test in diagnosis of ascending cholangitis and is the test of choice for patients who may need therapeutic drainage | ||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
=== Study of choice === | === Study of choice === | ||
'''Magnetic resonance cholangiopancreatography (MRCP)''' | '''[[MRCP|Magnetic resonance cholangiopancreatography (MRCP)]]''' | ||
* It is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of endoscopic retrograde cholangiopancreaticography (ERCP). | * It is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of [[ERCP|endoscopic retrograde cholangiopancreaticography (ERCP)]]. | ||
'''Endoscopic retrograde cholangiopancreatography (ERCP''')<ref name="pmid29226107">{{cite journal| author=Mohammad Alizadeh AH| title=Cholangitis: Diagnosis, Treatment and Prognosis. | journal=J Clin Transl Hepatol | year= 2017 | volume= 5 | issue= 4 | pages= 404-413 | pmid=29226107 | doi=10.14218/JCTH.2017.00028 | pmc=5719198 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29226107 }}</ref> | [[ERCP|'''Endoscopic retrograde cholangiopancreatography (ERCP''')]]:<ref name="pmid29226107">{{cite journal| author=Mohammad Alizadeh AH| title=Cholangitis: Diagnosis, Treatment and Prognosis. | journal=J Clin Transl Hepatol | year= 2017 | volume= 5 | issue= 4 | pages= 404-413 | pmid=29226107 | doi=10.14218/JCTH.2017.00028 | pmc=5719198 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29226107 }}</ref> | ||
*ERCP is a gold standard test in diagnosis of ascending cholangitis<ref name="pmid181915233">{{cite journal| author=Lee NK, Kim S, Lee JW, Kim CW, Kim GH, Kang DH et al.| title=Discrimination of suppurative cholangitis from nonsuppurative cholangitis with computed tomography (CT). | journal=Eur J Radiol | year= 2009 | volume= 69 | issue= 3 | pages= 528-35 | pmid=18191523 | doi=10.1016/j.ejrad.2007.11.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18191523 }}</ref> | *[[ERCP]] is a gold standard test in diagnosis of ascending cholangitis<ref name="pmid181915233">{{cite journal| author=Lee NK, Kim S, Lee JW, Kim CW, Kim GH, Kang DH et al.| title=Discrimination of suppurative cholangitis from nonsuppurative cholangitis with computed tomography (CT). | journal=Eur J Radiol | year= 2009 | volume= 69 | issue= 3 | pages= 528-35 | pmid=18191523 | doi=10.1016/j.ejrad.2007.11.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18191523 }}</ref> | ||
* ERCP is a procedure to examine the pancreatic and bile ducts | * [[ERCP]] is a procedure to examine the pancreatic and bile ducts | ||
* Direct observation of obstruction or bile duct stone is possible | * Direct observation of obstruction or bile duct stone is possible | ||
* Test of choice for patients who may need drainage | * Test of choice for patients who may need drainage | ||
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* Can also be used as reference test to determine the efficacy of other methods like [[Magnetic resonance cholangiopancreatography|MRCP]] | * Can also be used as reference test to determine the efficacy of other methods like [[Magnetic resonance cholangiopancreatography|MRCP]] | ||
* Preferred as a therapeutic method for biliary drainage usually as compared to diagnostic | * Preferred as a therapeutic method for biliary drainage usually as compared to diagnostic | ||
* ERCP has a higher rate of complications as compared to other endoscopic procedures. Some common complications include bleeding, trauma, [[pancreatitis]] | * [[ERCP]] has a higher rate of complications as compared to other endoscopic procedures. Some common complications include bleeding, trauma, [[pancreatitis]] | ||
=== TG-13 diagnostic criteria for acute cholangitis<ref name="pmid22825491">{{cite journal| author=Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA et al.| title=New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. | journal=J Hepatobiliary Pancreat Sci | year= 2012 | volume= 19 | issue= 5 | pages= 548-56 | pmid=22825491 | doi=10.1007/s00534-012-0537-3 | pmc=3429782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22825491 }}</ref> === | === TG-13 diagnostic criteria for acute cholangitis<ref name="pmid22825491">{{cite journal| author=Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA et al.| title=New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. | journal=J Hepatobiliary Pancreat Sci | year= 2012 | volume= 19 | issue= 5 | pages= 548-56 | pmid=22825491 | doi=10.1007/s00534-012-0537-3 | pmc=3429782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22825491 }}</ref> === | ||
Latest revision as of 23:06, 15 October 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]
Overview
MRCP is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of endoscopic retrograde cholangiopancreaticography (ERCP). However, ERCP is the gold standard test in diagnosis of ascending cholangitis and is the test of choice for patients who may need therapeutic drainage
Diagnostic Study of Choice
Study of choice
Magnetic resonance cholangiopancreatography (MRCP)
- It is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of endoscopic retrograde cholangiopancreaticography (ERCP).
Endoscopic retrograde cholangiopancreatography (ERCP):[1]
- ERCP is a gold standard test in diagnosis of ascending cholangitis[2]
- ERCP is a procedure to examine the pancreatic and bile ducts
- Direct observation of obstruction or bile duct stone is possible
- Test of choice for patients who may need drainage
- Also done directly in a patient with classic traid of acute cholangitis (fever, jaundice, abdominal pain)
- Has both diagnostic and therapeutic efficacy
- Can also be used as reference test to determine the efficacy of other methods like MRCP
- Preferred as a therapeutic method for biliary drainage usually as compared to diagnostic
- ERCP has a higher rate of complications as compared to other endoscopic procedures. Some common complications include bleeding, trauma, pancreatitis
TG-13 diagnostic criteria for acute cholangitis[3]
| Description | ||
|---|---|---|
| A=Systemic Inflammation | A1 | Fever >38C and/or Chills |
| A2 | Laboratory evidence of inflammatory response
WBC <4000 or >10,000/uL CRP more than or equal to 1mg/dl | |
| B=Cholestasis | B1 | Jaundice - Total bilirubin more than or equal to 2mg/dl |
| B2 | Abnormal liver function tests
ALP - More than 1.5 times upper limit of normal AST - More than 1.5 times upper limit of normal ALT - More than 1.5 times upper limit of normal GGT - More than 1.5 times upper limit of normal | |
| C= Imaging | C1 | Biliary dilation |
| C2 | Evidence of etiology on the imaging
(stricture, stone, stent) |
SUSPECTED DIAGNOSIS - One item in A + one item in either B or C
DEFINITE DIAGNOSIS - One item in A, one item in B and one item in C
References
- ↑ Mohammad Alizadeh AH (2017). "Cholangitis: Diagnosis, Treatment and Prognosis". J Clin Transl Hepatol. 5 (4): 404–413. doi:10.14218/JCTH.2017.00028. PMC 5719198. PMID 29226107.
- ↑ Lee NK, Kim S, Lee JW, Kim CW, Kim GH, Kang DH; et al. (2009). "Discrimination of suppurative cholangitis from nonsuppurative cholangitis with computed tomography (CT)". Eur J Radiol. 69 (3): 528–35. doi:10.1016/j.ejrad.2007.11.031. PMID 18191523.
- ↑ Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA; et al. (2012). "New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines". J Hepatobiliary Pancreat Sci. 19 (5): 548–56. doi:10.1007/s00534-012-0537-3. PMC 3429782. PMID 22825491.