Letter to the Editor
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2023; 29(5): 904-907
Published online Feb 7, 2023. doi: 10.3748/wjg.v29.i5.904
Timing of biliary decompression for acute cholangitis
Jian Yang, Ying Liu, Shi Liu
Jian Yang, Shi Liu, Central Laboratory, The Third Affiliated Hospital, Qiqihar Medical University, Qiqihar 161000, Heilongjiang Province, China
Ying Liu, Department of Medical Oncology, The Third Affiliated Hospital, Qiqihar Medical University, Qiqihar 161000, Heilongjiang Province, China
Author contributions: Yang J designed and wrote this report; Liu S gave guidance on article revision; Liu Y reviewed the literature and contributed to drafting the manuscript; All authors issued final approval for the version to be submitted.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi Liu, PhD, Chief Physician, Central Laboratory, The Third Affiliated Hospital, Qiqihar Medical University, No. 27 Taishun Street, Tiefeng, Qiqihar 161000, Heilongjiang Province, China. shiliu2199@163.com
Received: November 16, 2022
Peer-review started: November 16, 2022
First decision: January 2, 2023
Revised: January 3, 2023
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 7, 2023
Processing time: 82 Days and 4.5 Hours
Abstract

Severe acute cholangitis (AC) exacerbates the risk of death because of the rapid progression of the disease. The optimal timing of biliary decompression (BD) as a necessary intervention in patients with severe AC is controversial. A recently report titled “Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity” in the World Journal of Gastroenterology that the optimal time of endoscopic retrograde cholangiopancreatography for treating patients with severe AC is ≤ 48 but not ≤ 24 h, providing clinical evidence for selecting the optimal time for implementation of BD. Here, we discuss the controversy over the optimal timing of BD for AC based on guidelines and clinical evidence, and consider that more high-level clinical researches are urgent needed to benefit the management of patients with different severity of AC.

Keywords: Acute cholangitis; Biliary decompression; Endoscopic retrograde cholangiopancreatography; Severity; Optimal time; Clinical evidence

Core Tip: Severe acute cholangitis (AC) exacerbates the risk of death because of the rapid progression of the disease. The optimal timing of biliary decompression (BD) as an intervention for severe AC is controversial. The purpose of this letter is to highlight the controversy surrounding the existing clinical evidence regarding BD for the treatment of AC of varying severity and to suggest that clinical studies providing higher levels of evidence will improve the therapeutic benefits.