Interventional biliary techniques

Endoscopic and percutaneous intervention techniques have revolutionarized the management of patients with acute biliary tract disorders. Both acute cholangitis and biliary pancreatitis have been favorably affected by the endoscopic approach, and this should be the preferred method in most instances. Local expertise may vary widely and in some locales the percutaneous route may be preferred. If the endoscopic approach fails, particularly if contrast is injected above an obstruction, then radiographic backup should be available. Mechanical stone extraction may augment the success rate for stone removal at the original procedure, and mono-octanoin infusion may augment stone dissolution, but the other more sophisticated techniques have little application in the ICU setting. The paramount message is to obtain decompression, allow the clinical situation to stabilize, and later direct therapy toward the primary process.