Skip to main content
WoMWeb of Medicine
SearchGraphHistory
Gastroenterology›Condition·Updated Jun 3, 2026·v1

Acute Cholangitis

Acute cholangitis is a surgical emergency driven by biliary obstruction and infection. Diagnosis is standardized by the TG18 criteria, and management centers on rapid resuscitation, broad-spectrum antibiotics (e.g., Pip-Tazo), and urgent ERCP-guided decompression within 24 hours.

High Evidence207 references·8,245 words·33 min read·v1
gastroenterologycritical_carebiliary_sepsisERCPhepatology

Quick Reference

RxDrug of choice[[Piperacillin/tazobactam]] 4.5 g IV Q6H (for severe/healthcare-associated) or [[Ceftriaxone]] 2 g IV daily + [[Metronidazole]] 500 mg IV Q8H
AltAlternatives[[Meropenem]] 1 g IV Q8H (if ESBL suspected) or [[Levofloxacin]] 750 mg IV daily + [[Metronidazole]]
⊘AvoidAvoid elective [[cholecystectomy]] during the hyper-acute phase of sepsis before biliary decompression is achieved.
DxTest of choice[[ERCP]] (Diagnostic and Therapeutic); [[MRCP]] (Non-invasive diagnostic gold standard)
ScKey score[[Tokyo Guidelines 2018]] (TG18) Severity Grading
→When to referRefer to Interventional Gastroenterology or IR immediately for any Grade II or III disease requiring urgent decompression.
Acute cholangitis is a medical emergency; the combination of IV antibiotics and urgent biliary decompression (<24h) is mandatory to prevent death from biliary sepsis.
Acute cholangitis is a life-threatening clinical syndrome characterized by inflammation and infection of the biliary tree, typically resulting from the synergistic combination of biliary obstruction and bacterial proliferation. Historically defined by Charcot's triad (fever, jaundice, and right upper quadrant pain), modern diagnosis relies on the more sensitive [[Tokyo Guidelines 2018]] (TG18) criteria, which integrate systemic inflammatory markers, cholestatic laboratory findings, and cross-sectional imaging. The central pathophysiology involves a critical rise in intraductal pressure (>20 cm H2O), facilitating the translocation of enteric bacteria into the systemic circulation. Management is a medical-surgical emergency requiring aggressive fluid resuscitation, broad-spectrum antimicrobial therapy, and, most crucially, mechanical biliary decompression. Delays in decompression beyond 24 hours significantly increase mortality, which ranges from 1.2% in mild cases to over 8% in severe (Grade III) disease characterized by organ dysfunction.

Overview and Recommendations

Background

  • •Acute cholangitis represents a critical failure of the biliary-venous barrier, where intraductal pressures exceeding 20 cm H2O force bacteria and endotoxins directly into the hepatic venous sinuses and lymphatics. While the biliary tree is normally maintained at low pressures (7–14 cm H2O) and kept sterile by the flushing action of bile and secretory IgA, mechanical obstruction—most commonly from (gallstones), strictures, or malignancy—triggers rapid bacterial proliferation and systemic endotoxemia.
  • •The epidemiological landscape is bifurcating into two distinct high-risk populations: a geriatric cohort dominated by calculous disease (median age >80 years) and a younger, predominantly male cohort (median age ~48 years) with (PSC), often associated with . Iatrogenic triggers, particularly post- infections and -induced pseudolithiasis, represent increasingly common healthcare-associated causes that often involve multi-drug resistant organisms.
  • •Microbiological profiles are dominated by enteric Gram-negative rods, with (25–50%), species (15–20%), and species being the most frequent isolates. However, polymicrobial infections are common in patients with prior biliary-enteric anastomoses or indwelling stents, where species and anaerobes like play a significant role in driving systemic inflammatory response syndrome (SIRS).
  • •The paradigm shift from the historical Charcot's triad (1877) to the modern (TG18) has dramatically improved diagnostic sensitivity. While the classic triad is highly specific (~93%), it is absent in up to 50% of confirmed cases; the TG18 framework achieves a sensitivity >90% by incorporating laboratory markers like C-reactive protein (CRP) and advanced imaging findings to identify biliary sepsis before the onset of Reynolds' pentad (triad plus shock and altered mental status).

Evaluation

  • •Suspect acute cholangitis in any patient presenting with the classic triad of fever, jaundice, and right upper quadrant pain, but maintain a high index of clinical suspicion in elderly or immunocompromised patients who may present only with altered mental status or unexplained hypotension. Early recognition of biliary sepsis is vital, as the transition from localized infection to systemic shock can occur within hours of symptom onset.
  • •Examine the patient for signs of impending organ failure, specifically looking for tachycardia, hypotension (SBP < 90 mmHg), and tachypnea. Assess for septic encephalopathy (confusion or lethargy) and perform a thorough abdominal exam; while RUQ tenderness is common, the presence of guarding or rebound tenderness should prompt concern for concomitant or gallbladder perforation.
  • •Order immediate laboratory studies including a complete blood count (WBC), C-reactive protein (CRP), and a comprehensive metabolic panel (CMP) to evaluate liver function. Diagnostic thresholds under TG18 include a WBC < 4,000 or > 10,000/µL, CRP ≥ 1 mg/dL, and cholestatic markers such as serum bilirubin ≥ 2 mg/dL or alkaline phosphatase (ALP) > 1.5x the upper limit of normal.
  • •Obtain blood cultures (two sets) before initiating antibiotics, as they are positive in 20–30% of cases and guide narrowing of therapy. While bile cultures often yield more organisms, blood cultures are the primary tool for identifying the systemic pathogen driving the septic response.
  • •Perform transabdominal ultrasound as the initial imaging modality to screen for and biliary ductal dilation. While ultrasound is highly specific for stones, it has limited sensitivity for distal common bile duct (CBD) stones; therefore, a negative ultrasound in a patient with high clinical suspicion must be followed by more sensitive cross-sectional imaging.
  • •Order contrast-enhanced of the abdomen or if ultrasound is inconclusive or if malignancy is suspected. CT is superior for identifying the level of obstruction and complications like liver abscesses, while MRCP is the non-invasive gold standard for mapping the biliary tree and identifying subtle strictures or small stones.
  • •Apply the TG18 severity grading system immediately to dictate the timing of intervention. Grade III (Severe) is defined by any new organ dysfunction (e.g., PaO2/FiO2 < 300, Platelets < 100k, or need for vasopressors); Grade II (Moderate) includes patients with high fever (≥39°C), age ≥75, or bilirubin ≥5 mg/dL; Grade I (Mild) is a diagnosis of exclusion in those responding to initial therapy.
  • •Consider specialized testing if autoimmune etiologies are suspected, such as serum IgG4 levels for or p-ANCA for . In patients on immune checkpoint inhibitors (e.g., ), be alert for immune-related cholangitis which may present with concurrent hepatitis.

Management

  • •Initiate aggressive fluid resuscitation immediately following the Surviving Sepsis Campaign bundles, administering 30 mL/kg of balanced crystalloid (e.g., Lactated Ringer's) within the first 3 hours for patients with hypotension or lactate ≥ 4 mmol/L. Target a mean arterial pressure (MAP) ≥ 65 mmHg, utilizing norepinephrine if shock is refractory to fluids.
  • •Administer empiric broad-spectrum IV antibiotics within one hour of recognition. For community-acquired Grade I or II disease, 1–2 g daily plus 500 mg every 8 hours is appropriate; for Grade III or healthcare-associated cases, use 4.5 g every 6 hours to ensure coverage against and .
  • •Perform urgent biliary decompression within 24 hours for all patients with acute cholangitis, as this is the only definitive treatment for the septic focus. For Grade III (Severe) cases, decompression should ideally occur within 12 hours once the patient is hemodynamically stabilized.
  • •Utilize as the first-line modality for decompression. In the setting of sepsis-induced coagulopathy, prioritize simple biliary drainage (via plastic stent or nasobiliary tube) over endoscopic sphincterotomy (EST) to minimize the risk of procedural bleeding.
  • •Refer for (PTBD) or -guided biliary drainage (EUS-BD) if ERCP fails or is technically unfeasible due to altered surgical anatomy (e.g., Roux-en-Y gastric bypass). PTBD is particularly effective for high hilar (Klatskin) obstructions.
  • •Monitor for post-procedural complications, including , bleeding, and perforation. In patients with Grade III disease, continue intensive care monitoring for at least 24–48 hours post-decompression to ensure resolution of organ dysfunction.
  • •Tailor antibiotic therapy based on culture results once the patient is clinically stable. While the standard duration is 4–7 days, therapy may be shortened to 24–48 hours following successful and complete biliary drainage in uncomplicated calculous disease.
  • •Schedule definitive treatment of the underlying cause once the acute infection has resolved. For calculous disease, this typically involves a during the same hospital admission to prevent recurrent biliary events.
  • •Avoid the use of non-dihydropyridine calcium channel blockers or other drugs that may worsen biliary stasis during the acute phase. In patients with PSC, consider the long-term use of (UDCA) 13–15 mg/kg/day, though its role in preventing acute infectious episodes is limited.
  • •Discharge the patient only once they are afebrile for 24 hours, have a declining trend in inflammatory markers, and have achieved definitive biliary source control. Ensure a follow-up plan for repeat imaging or stent removal/exchange if temporary drainage was utilized.

Board Review — High Yield

  • •Charcot's Triad — Fever, Jaundice, RUQ pain (High specificity, low sensitivity for cholangitis).
  • •Reynolds' Pentad — Charcot's triad plus hypotension and altered mental status (indicates suppurative cholangitis and high mortality).
  • •20 cm H2O Rule — The critical intraductal pressure threshold for biliary-venous reflux and systemic bacterial translocation.
  • •Tokyo Guidelines 2018 — The current gold standard for diagnosis, requiring evidence of systemic inflammation, cholestasis, and imaging findings.
  • •Most Common Organism — [[Escherichia coli]] is the most frequently isolated pathogen in bile and blood cultures.
  • •Timing of ERCP — Urgent (<24h) decompression is associated with significantly lower mortality compared to delayed intervention.
  • •Primary Sclerosing Cholangitis (PSC) — A chronic risk factor for recurrent cholangitis, often associated with [[ulcerative colitis]] and an increased risk of [[cholangiocarcinoma]].
  • •Ceftriaxone Pseudolithiasis — A known side effect where ceftriaxone precipitates with calcium in bile, potentially mimicking or causing biliary obstruction.

Deep Dive — Evidence Details

References

  1. [1]

    Trauner M, Levy C, Tanaka A et al.. “Cilofexor in non-cirrhotic primary sclerosing cholangitis (PRIMIS): a randomised, double-blind, multicentre, placebo-controlled, phase 3 trial.” The lancet. Gastroenterology & hepatology (2026). PMID: 41173015 ↗

    L1RCTCited in: Definition, Classification, and Historical Context
  2. [2]

    Theodoros V, Fotios F, Konstantinos M et al.. “HERACLIS-PSC: Current characteristics of primary sclerosing cholangitis with or without inflammatory bowel disease in Greece-a national multicenter cohort study.” Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (2026). PMID: 41577581 ↗

    L2COHORTCited in: Definition, Classification, and Historical Context, Epidemiology and Risk Factors, Clinical Presentation and Physical Examination
  3. [3]

    Mammadov RA, Roest HP, van der Laan LJ et al.. “Dietary and Lifestyle Risk Factors in Primary Sclerosing Cholangitis: In Search of Mechanistic Explanations and Health Improvement.” The Journal of nutrition (2025). PMID: 41176278 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification, and Historical Context
  4. [4]

    Aziz H, Seda P, Gosse M et al.. “Intraductal papillary neoplasm of the bile duct.” HPB : the official journal of the International Hepato Pancreato Biliary Association (2025). PMID: 41006119 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification, and Historical Context, Laboratory and Radiologic Evaluation
  5. [5]

    Curto A, Cristoferi L, Carbone M et al.. “Primary sclerosing cholangitis: what is new in the therapeutic landscape.” Current opinion in immunology (2025). PMID: 40683116 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification, and Historical Context
  6. [6]

    Naitoh I, Yoshida M, Nakazawa T. “Endoscopic diagnosis of immunoglobulin G4-related sclerosing cholangitis.” Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (2025). PMID: 40256978 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification, and Historical Context, Laboratory and Radiologic Evaluation
  7. [7]

    Angelescu C, Cozma MA, Mateescu RB et al.. “Comparison of NLR and CRP in Identifying Organ Dysfunction-Based Severe Presentation of Acute Cholangitis in Patients with Choledocholithiasis: A Single-Center Retrospective Study.” Medicina (Kaunas, Lithuania) (2026). PMID: 42195068 ↗

    L3COHORTCited in: Definition, Classification, and Historical Context, Epidemiology and Risk Factors, Severity Grading and Risk Stratification
  8. [8]

    Comoglu E, Acehan F, Altiparmak E et al.. “Early identification of the need for biliary drainage in acute calculous cholangitis: a prospective cohort study.” European journal of gastroenterology & hepatology (2026). PMID: 41925043 ↗

    L2COHORTCited in: Definition, Classification, and Historical Context, Severity Grading and Risk Stratification, Management of Underlying Etiologies, Complications and Long-term Outcomes
  9. [9]

    Chen QQ, Shao CK, Zhang YW et al.. “Clinicopathological features of hepatic Langerhans cell histiocytosis: report of ten cases and review of the literature.” Annals of diagnostic pathology (2026). PMID: 41264975 ↗

    L4CASE_REPORTCited in: Definition, Classification, and Historical Context
  10. [10]

    Zheng J, Mo J, Xiong J et al.. “Sustained abnormal bilirubin and leukocyte levels after ERCP with acute suppurative obstructive cholangitis: a case report with 2 months follow-up observation.” Frontiers in immunology (2026). PMID: 41918747 ↗

    L4CASE_REPORTCited in: Definition, Classification, and Historical Context, Biliary Decompression: Timing and Modalities
  11. [11]

    Kawata K, Inoue D, Komori T et al.. “Case of simultaneous occurrence of hepatitis, cholangitis, and pancreatitis as immune-related adverse events induced by immune checkpoint inhibitor therapy: a case report.” Abdominal radiology (New York) (2025). PMID: 40423705 ↗

    L4CASE_REPORTCited in: Definition, Classification, and Historical Context, Laboratory and Radiologic Evaluation, Initial Medical Management and Antimicrobial Therapy
  12. [12]

    Calinescu AM, Wildhaber BE. “Post-Kasai cholangitis evaluation and management strategies: Review of the literature with insights from the Swiss Biliary Atresia Registry.” Seminars in pediatric surgery (2024). PMID: 39862689 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification, and Historical Context
  13. [13]

    Bergquist A, Ekstedt M, Hagström H et al.. “Forty years of successful national research collaboration in liver disease - the Swedish experience.” Scandinavian journal of gastroenterology (2024). PMID: 39485016 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification, and Historical Context
  14. [14]

    Kamezaki H, Iwanaga T, Maeda T et al.. “Risk of Pseudogallstones and Biliary Complications in Rehabilitation Patients Administered Ceftriaxone: A Retrospective Study.” JGH open : an open access journal of gastroenterology and hepatology (2025). PMID: 40589767 ↗

    L4COHORTCited in: Definition, Classification, and Historical Context, Epidemiology and Risk Factors
  15. [15]

    Deng D, Yuan Q, Pan C et al.. “Non-invasive liquid biopsy based on metabolomic profiling improves diagnosis and early warning of severe acute pancreatitis.” NPJ digital medicine (2026). PMID: 41611815 ↗

    L2OTHERCited in: Definition, Classification, and Historical Context
  16. [16]

    Hirschfield GM, Kowdley KV, Trivedi PJ et al.. “Phase II INTEGRIS-PSC trial of bexotegrast, an αvβ6/αvβ1 integrin inhibitor, in primary sclerosing cholangitis.” Journal of hepatology (2026). PMID: 41016442 ↗

    L1RCTCited in: Epidemiology and Risk Factors
  17. [17]

    Yang Y, Wang Y, Chen Q et al.. “Analysis of the effectiveness and safety of endoscopic retrograde cholangiopancreatography versus percutaneous transhepatic biliary drainage in severe acute cholangitis caused by common bile duct stones.” Updates in surgery (2026). PMID: 40775581 ↗

    L1RCTCited in: Epidemiology and Risk Factors, Biliary Decompression: Timing and Modalities, Alternative Decompression: PTBD and Surgical Intervention
  18. [18]

    Cristoferi L, D'Amato D, Maino C et al.. “Prospective, randomised, placebo-controlled, phase 2 clinical trial assessing the efficacy and safety of oral vancomycin in patients with primary sclerosing cholangitis with/out inflammatory bowel disease in Italy: study protocol of VanC-IT trial.” BMJ open (2026). PMID: 41513411 ↗

    L5TRIAL_NONRANDOMCited in: Epidemiology and Risk Factors, Laboratory and Radiologic Evaluation, Initial Medical Management and Antimicrobial Therapy
  19. [19]

    Vitor IC, Tomé MR, Amador WFO et al.. “Primary Sclerosing Cholangitis Recurrence After Liver Transplantation: A Systematic Review and Updated Meta-Analysis.” Liver international : official journal of the International Association for the Study of the Liver (2026). PMID: 42163804 ↗

    L2SR_OBSCited in: Epidemiology and Risk Factors
  20. [20]

    Desouky M, Altawil L, Al Hayek M et al.. “The efficacy and safety of magnetic compression anastomosis in the management of biliary obstruction: a systematic review and meta-analysis.” Surgical endoscopy (2026). PMID: 41651954 ↗

    L2SR_OBSCited in: Epidemiology and Risk Factors, Management of Underlying Etiologies
  21. [21]

    Faleiro MD, de M Ogawa T, Correia PP et al.. “Updated Systematic Review and Meta-Analysis of Duct-to-duct Versus Hepaticojejunostomy Reconstruction After Liver Transplantation for Primary Sclerosing Cholangitis.” Transplantation (2026). PMID: 41572464 ↗

    L2SR_OBSCited in: Epidemiology and Risk Factors, Complications and Long-term Outcomes
  22. [22]

    Garg A, Moond V, Garg A et al.. “Endoscopic balloon dilation versus stent placement in the management of dominant strictures in primary sclerosing cholangitis: a systematic review and meta-analysis.” Gastrointestinal endoscopy (2026). PMID: 40846243 ↗

    L2SR_OBSCited in: Epidemiology and Risk Factors
  23. [23]

    Liu X, Wang Y, Han J et al.. “Risk factors for cholangitis after Kasai procedure in biliary atresia patients: a systematic review and meta-analysis.” International journal of surgery (London, England) (2025). PMID: 40844888 ↗

    L2SR_OBSCited in: Epidemiology and Risk Factors
  24. [24]

    Chen ML, Wang XL, Yu H et al.. “Biliary stenting combined with intraluminal 125 I seed brachytherapy versus biliary stenting alone for the treatment of cholangiocarcinoma: a meta-analysis.” International journal of surgery (London, England) (2025). PMID: 40679970 ↗

    L1SR_OBSCited in: Epidemiology and Risk Factors
  25. [25]

    Seeßle J, Ruhberg L, Kirchner M et al.. “Assessing the effect of single dose antibiotic prophylaxis compared with a multiday regimen in liver transplant recipients undergoing routine endoscopic retrograde cholangiopancreatography: a retrospective, single-centre, registry-based cohort study with a historical control group.” BMJ open gastroenterology (2026). PMID: 41974487 ↗

    L3COHORTCited in: Epidemiology and Risk Factors, Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Severity Grading and Risk Stratification, Initial Medical Management and Antimicrobial Therapy, Biliary Decompression: Timing and Modalities, Complications and Long-term Outcomes
  26. [26]

    Älgå LL, Ekheden I, Thuresson M et al.. “Risk of primary sclerosing cholangitis among patients with gastritis: a nationwide cohort study.” European journal of epidemiology (2025). PMID: 40847211 ↗

    L2COHORTCited in: Epidemiology and Risk Factors
  27. [27]

    Abdalla M, Eberhardson M, Landerholm K et al.. “Impact of Inflammatory Bowel Disease and Primary Sclerosing Cholangitis on Colorectal Cancer Risk: National Cohort Study.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2026). PMID: 40706734 ↗

    L2COHORTCited in: Epidemiology and Risk Factors
  28. [28]

    Huang Y, Yin Z, Han W. “Anion gap associated with 28-days all-cause mortality in Acute cholangitis patients admitted to the intensive care unit in MIMIC-IV database: a retrospective cohort study.” Frontiers in medicine (2025). PMID: 40486199 ↗

    L3COHORTCited in: Epidemiology and Risk Factors
  29. [29]

    Taniguchi J, Aso S, Matsui H et al.. “Association Between Ceftriaxone Use and Biliary Infections in Patients With Pneumonia: A Nationwide Retrospective Cohort Study.” Pharmacoepidemiology and drug safety (2025). PMID: 40398875 ↗

    L3COHORTCited in: Epidemiology and Risk Factors, Initial Medical Management and Antimicrobial Therapy
  30. [30]

    Kulkarni C, Cholankeril G, Fardeen T et al.. “Statin Use Is Associated With Protection Against Acute Cholangitis in Patients With Primary Sclerosing Cholangitis: A Multicenter Retrospective Cohort Study.” Clinical and translational gastroenterology (2025). PMID: 40272937 ↗

    L3COHORTCited in: Epidemiology and Risk Factors
  31. [31]

    Holmer M, Ingre M, Färkkilä M et al.. “Cirrhosis and age are key determinants of HCC risk in individuals with primary sclerosing cholangitis: A multicenter longitudinal cohort study.” Hepatology (Baltimore, Md.) (2026). PMID: 40238209 ↗

    L2COHORTCited in: Epidemiology and Risk Factors, Management of Underlying Etiologies
  32. [32]

    Hof A, Rey R, Rock N et al.. “Etiology and management of cholangitis in pediatric liver transplant recipients: a systematic review.” Current opinion in organ transplantation (2026). PMID: 41947725 ↗

    L2SR_OBSCited in: Epidemiology and Risk Factors, Laboratory and Radiologic Evaluation, Initial Medical Management and Antimicrobial Therapy
  33. [33]

    Zhang CC, Koschny R, Rupp C et al.. “Post-endoscopic retrograde cholangiopancreatography cholangitis after endoscopic treatment of post-transplant biliary strictures: a retrospective study.” BMC surgery (2025). PMID: 40783752 ↗

    L3COHORTCited in: Epidemiology and Risk Factors, Biliary Decompression: Timing and Modalities
  34. [34]

    Vorasittha A, Sakamoto S, Yanagi Y et al.. “Recurrence of Primary Sclerosing Cholangitis After Pediatric Liver Transplantation: A Single-Center, Retrospective Study in Japan.” Pediatric transplantation (2025). PMID: 40217566 ↗

    L4COHORTCited in: Epidemiology and Risk Factors
  35. [35]

    Wan Y, Zheng M, Fu W et al.. “Research trends on autoimmune liver diseases and gut microbiota (1989-2025): a bibliometric and visualization analysis based on the web of science core collection database.” Frontiers in immunology (2026). PMID: 42136643 ↗

    L5OTHERCited in: Epidemiology and Risk Factors
  36. [36]

    An J, Ahn SH, Kim KH et al.. “Twenty-year temporal trends, risk profiles, and prognostic value of clinicopathological features in gallbladder cancer following cholecystectomy.” World journal of gastroenterology (2026). PMID: 41694497 ↗

    L3OTHERCited in: Epidemiology and Risk Factors
  37. [37]

    Hiroshima Y, Sagami R, Kuraoka N et al.. “Sphincterotomy during endoscopic biliary drainage in cholangitis with sepsis-induced coagulopathy increases bleeding without clinical benefits.” Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (2026). PMID: 41656119 ↗

    L3OTHERCited in: Epidemiology and Risk Factors, Biliary Decompression: Timing and Modalities
  38. [38]

    Elzubeir A, High J, Hammond M et al.. “Assessing brodalumab in the treatment of primary sclerosing cholangitis (SABR-PSC pilot study): protocol for a single-arm, multicentre, pilot study.” BMJ open gastroenterology (2025). PMID: 40032516 ↗

    L5TRIAL_NONRANDOMCited in: Pathophysiology and Microbiology
  39. [39]

    Moniruzzaman M, Shah A, Fairlie T et al.. “Immune Activation in Primary Sclerosing Cholangitis: A Systematic Review and Comparative Analysis With Inflammatory Bowel Diseases.” United European gastroenterology journal (2025). PMID: 41026618 ↗

    L2SR_OBSCited in: Pathophysiology and Microbiology
  40. [40]

    Halimi H, Hesami Z, Asri N et al.. “Exploring the biliary microbiome in hepatopancreatobiliary disorders: a comprehensive systematic review of microbial signatures and diagnostic potential.” BMC gastroenterology (2025). PMID: 41408188 ↗

    L2SR_OBSCited in: Pathophysiology and Microbiology, Complications and Long-term Outcomes
  41. [41]

    Ledenko T, Sorić Hosman I, Ćorić M et al.. “Case Report: Simultaneously Developed Amyopathic Dermatomyositis and Autoimmune Sclerosing Cholangitis - a Coincidence or a Shared Immunopathogenesis?” Frontiers in immunology (2022). PMID: 35281002 ↗

    L4CASE_REPORTCited in: Pathophysiology and Microbiology, Clinical Presentation and Physical Examination
  42. [42]

    Jalan-Sakrikar N, Anwar AA, Ali A et al.. “Cholangiocyte biology in primary sclerosing cholangitis and other cholangiopathies: pathogenesis, clinical insights, and experimental tools.” Physiological reviews (2026). PMID: 41973609 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  43. [43]

    Pan W, Yong Y, Li Y et al.. “Hepatocyte Mettl3 Deficiency Drives Primary Sclerosing Cholangitis and Liver Fibrosis via Cholangiocyte-Macrophage Crosstalk.” Advanced science (Weinheim, Baden-Wurttemberg, Germany) (2026). PMID: 41431138 ↗

    L5OTHERCited in: Pathophysiology and Microbiology
  44. [44]

    Das TS, Vuppalanchi R. “Future Treatment Options for Managing Primary Sclerosing Cholangitis and Cholestatic Pruritus.” Clinics in liver disease (2025). PMID: 41109703 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  45. [45]

    Wei S, Lu J. “Microbial Modulation of the Gut-Liver Axis in Autoimmune Liver Diseases.” Seminars in liver disease (2025). PMID: 40865561 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  46. [46]

    Grewal T, Tews HC, Buechler C. “Galectin-3-Insights from Inflammatory Bowel Disease and Primary Sclerosing Cholangitis.” International journal of molecular sciences (2025). PMID: 40649879 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  47. [47]

    Kolev M, Kremer AE, Sokollik C et al.. “Unmet needs in autoimmune liver diseases.” Current opinion in immunology (2025). PMID: 40414140 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  48. [48]

    Kodilinye SM, Shiratori Y, Kalloo AN. “Avoiding the complications of endoscopic retrograde cholangiopancreatography.” Current opinion in gastroenterology (2025). PMID: 40402845 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  49. [49]

    Manns MP, Bergquist A, Karlsen TH et al.. “Primary sclerosing cholangitis.” Nature reviews. Disease primers (2025). PMID: 40082445 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  50. [50]

    Mizuno S, Uchida Y, Ando S et al.. “Endoscopic management of primary sclerosing cholangitis.” Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (2025). PMID: 40049717 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology, Management of Underlying Etiologies
  51. [51]

    Noble A, Motta R, Cabras S et al.. “Epigenetic age acceleration and methylation differences in IgG4-related cholangitis and primary sclerosing cholangitis.” Clinical epigenetics (2025). PMID: 39819503 ↗

    L3OTHERCited in: Pathophysiology and Microbiology
  52. [52]

    Bjornsson ES, Arnedillo D, Bessone F. “Secondary Sclerosing Cholangitis due to Drugs With a Special Emphasis on Checkpoint Inhibitors.” Liver international : official journal of the International Association for the Study of the Liver (2025). PMID: 39620448 ↗

    L4REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  53. [53]

    Bjornsson ES, Devarbhavi HC. “Drug-induced cholestatic liver diseases.” Hepatology (Baltimore, Md.) (2025). PMID: 39121063 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  54. [54]

    Lammert F, Wittenburg H. “Gallstones: Prevention, Diagnosis, and Treatment.” Seminars in liver disease (2024). PMID: 39095030 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  55. [55]

    Dorner H, Stolzer I, Mattner J et al.. “Gut Pathobiont-Derived Outer Membrane Vesicles Drive Liver Inflammation and Fibrosis in Primary Sclerosing Cholangitis-Associated Inflammatory Bowel Disease.” Gastroenterology (2024). PMID: 38992449 ↗

    L5OTHERCited in: Pathophysiology and Microbiology
  56. [56]

    Gassiep I, Edwards F, Laupland KB. “Epidemiology of biliary tract-associated bloodstream infections and adequacy of empiric therapy: an Australian population-based study.” European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2024). PMID: 38985222 ↗

    L2OTHERCited in: Pathophysiology and Microbiology
  57. [57]

    Kayashima A, Sujino T, Fukuhara S et al.. “Unique bile acid profiles in the bile ducts of patients with primary sclerosing cholangitis.” Hepatology communications (2024). PMID: 38780302 ↗

    L3OTHERCited in: Pathophysiology and Microbiology
  58. [58]

    Motta RV, Saffioti F, Mavroeidis VK. “Hepatolithiasis: Epidemiology, presentation, classification and management of a complex disease.” World journal of gastroenterology (2024). PMID: 38659478 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  59. [59]

    Isogai M. “Pathophysiology of severe gallstone pancreatitis: A new paradigm.” World journal of gastroenterology (2024). PMID: 38515949 ↗

    L5OTHERCited in: Pathophysiology and Microbiology
  60. [60]

    D'Amato D, Carbone M. “Prognostic models and autoimmune liver diseases.” Best practice & research. Clinical gastroenterology (2023). PMID: 38103932 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  61. [61]

    Nishiwaki R, Imoto I, Oka S et al.. “Elevated plasma and bile levels of corisin, a microbiota-derived proapoptotic peptide, in patients with severe acute cholangitis.” Gut pathogens (2023). PMID: 38037145 ↗

    L3OTHERCited in: Pathophysiology and Microbiology
  62. [62]

    Houri I, Hirschfield GM. “Primary Biliary Cholangitis: Pathophysiology.” Clinics in liver disease (2024). PMID: 37945164 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  63. [63]

    Zapata M, Pagan-Torres H, Mayo MJ. “Systemic Complications of Primary Biliary Cholangitis.” Clinics in liver disease (2024). PMID: 37945153 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  64. [64]

    van Munster KN, Bergquist A, Ponsioen CY. “Inflammatory bowel disease and primary sclerosing cholangitis: One disease or two?” Journal of hepatology (2024). PMID: 37940453 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  65. [65]

    Grama A, Mititelu A, Sîrbe C et al.. “Immune-mediated cholangiopathies in children: the need to better understand the pathophysiology for finding the future possible treatment targets.” Frontiers in immunology (2023). PMID: 37928553 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology and Microbiology
  66. [66]

    Pratt HE, Wu T, Elhajjajy S et al.. “Beyond genome-wide association studies: Investigating the role of noncoding regulatory elements in primary sclerosing cholangitis.” Hepatology communications (2023). PMID: 37756045 ↗

    L5OTHERCited in: Pathophysiology and Microbiology
  67. [67]

    Del Chierico F, Cardile S, Baldelli V et al.. “Characterization of the Gut Microbiota and Mycobiota in Italian Pediatric Patients With Primary Sclerosing Cholangitis and Ulcerative Colitis.” Inflammatory bowel diseases (2024). PMID: 37696680 ↗

    L3OTHERCited in: Pathophysiology and Microbiology
  68. [68]

    Wang M, Harris A, McCulloch CE et al.. “Racial differences in primary sclerosing cholangitis: A retrospective cohort study leveraging a new ICD-10 code.” Annals of hepatology (2025). PMID: 40081809 ↗

    L2COHORTCited in: Clinical Presentation and Physical Examination
  69. [69]

    Pi B, Wang J, Tong Y et al.. “Immune-related cholangitis induced by immune checkpoint inhibitors: a systematic review of clinical features and management.” European journal of gastroenterology & hepatology (2021). PMID: 34482313 ↗

    L4SR_OBSCited in: Clinical Presentation and Physical Examination
  70. [70]

    Kunlayawutipong T, Pattarapuntakul T, Wong T et al.. “IgG4-related cholangitis - distinguishing from other benign biliary strictures: clinical features, imaging, and response to treatment: a retrospective study.” BMC gastroenterology (2025). PMID: 40640699 ↗

    L3COHORTCited in: Clinical Presentation and Physical Examination, Laboratory and Radiologic Evaluation, Management of Underlying Etiologies
  71. [71]

    Chen Q, Kong D, Liu X. “Secondary sclerosing cholangitis due to drug-induced liver injury: a retrospective cohort study.” European journal of gastroenterology & hepatology (2025). PMID: 39621869 ↗

    L3COHORTCited in: Clinical Presentation and Physical Examination
  72. [72]

    Kihara Y, Yokomizo H. “The clinical features of late postoperative cholangitis following pancreaticoduodenectomy brought on by conditions other than cancer recurrence: a single-center retrospective study.” BMC surgery (2022). PMID: 35932000 ↗

    L3COHORTCited in: Clinical Presentation and Physical Examination
  73. [73]

    Li M, Wang A, Ren S et al.. “Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study.” Scandinavian journal of gastroenterology (2022). PMID: 35297730 ↗

    L3COHORTCited in: Clinical Presentation and Physical Examination
  74. [74]

    von Seth E, Karlsen TH, Tanaka A et al.. “Primary sclerosing cholangitis.” Lancet (London, England) (2026). PMID: 41871593 ↗

    L5REVIEW_NARRATIVECited in: Clinical Presentation and Physical Examination
  75. [75]

    Chaouch MA, Dougaz MW, Bergaoui MM et al.. “Validation of charcot's triad and Tokyo guidelines 2018 as a diagnostic tool for acute ascending cholangitis secondary to a liver cystic echinococcosis.” BMC infectious diseases (2025). PMID: 41023890 ↗

    L3OTHERCited in: Clinical Presentation and Physical Examination, Tokyo Guidelines 2018 (TG18) Diagnostic Criteria
  76. [76]

    Hue NT, Thi Huyen Trang N, Anh Tuan N et al.. “Delayed endoscopic retrograde cholangiopancreatography: a game-changer for acute cholangitis patients in a resource-limited setting.” Therapeutic advances in gastroenterology (2025). PMID: 40297202 ↗

    L2OTHERCited in: Clinical Presentation and Physical Examination, Initial Medical Management and Antimicrobial Therapy
  77. [77]

    Yasuda T, Ito T, Ishikawa T et al.. “Clinical features and pathological findings by liver biopsy in patients with immune-related sclerosing cholangitis induced by immune checkpoint inhibitors.” Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (2025). PMID: 39828442 ↗

    L3OTHERCited in: Clinical Presentation and Physical Examination
  78. [78]

    Jang Y, Kim JY, Han SY et al.. “Establishment of a chronic biliary disease mouse model with cholecystoduodenal anastomosis for intestinal microbiome preservation.” World journal of gastroenterology (2024). PMID: 39679313 ↗

    L5OTHERCited in: Clinical Presentation and Physical Examination
  79. [79]

    Xu X, Meng T, Shi L et al.. “Prevalence and clinical profiles of primary sclerosing cholangitis in China: Data from electronic medical records and systematic literature retrieval.” Journal of autoimmunity (2024). PMID: 38843578 ↗

    L2OTHERCited in: Clinical Presentation and Physical Examination
  80. [80]

    Thylin M, Färkkilä M, Kautiainen H et al.. “The new definition of dominant stricture in primary sclerosing cholangitis: Prevalence and clinical significance.” Liver international : official journal of the International Association for the Study of the Liver (2024). PMID: 38842451 ↗

    L2OTHERCited in: Clinical Presentation and Physical Examination
  81. [81]

    Yamamoto T, Mizuno K, Ito T et al.. “Abdominal pain accompanied by elevated serum inflammatory markers and biliary enzymes for diagnosing immune checkpoint inhibitor-induced sclerosing cholangitis.” Investigational new drugs (2023). PMID: 37171720 ↗

    L3OTHERCited in: Clinical Presentation and Physical Examination
  82. [82]

    Assis DN, Bowlus CL. “Recent Advances in the Management of Primary Sclerosing Cholangitis.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2023). PMID: 37084929 ↗

    L5REVIEW_NARRATIVECited in: Clinical Presentation and Physical Examination
  83. [83]

    Morgan MA, Khot R, Sundaram KM et al.. “Primary sclerosing cholangitis: review for radiologists.” Abdominal radiology (New York) (2023). PMID: 36063181 ↗

    L5REVIEW_NARRATIVECited in: Clinical Presentation and Physical Examination
  84. [84]

    Ludwig DR, Anderson MA, Itani M et al.. “Secondary sclerosing cholangitis: mimics of primary sclerosing cholangitis.” Abdominal radiology (New York) (2023). PMID: 35585354 ↗

    L5REVIEW_NARRATIVECited in: Clinical Presentation and Physical Examination
  85. [85]

    Tian S, Li K, Tang H et al.. “Clinical characteristics of Gram-negative and Gram-positive bacterial infection in acute cholangitis: a retrospective observational study.” BMC infectious diseases (2022). PMID: 35307004 ↗

    L3OTHERCited in: Clinical Presentation and Physical Examination
  86. [86]

    Yokoe M, Takada T, Strasberg SM et al.. “TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos).” Journal of hepato-biliary-pancreatic sciences (2013). PMID: 23340953 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Severity Grading and Risk Stratification, Landmark Evidence and Guideline Evolution
  87. [87]

    Higuchi R, Takada T, Strasberg SM et al.. “TG13 miscellaneous etiology of cholangitis and cholecystitis.” Journal of hepato-biliary-pancreatic sciences (2013). PMID: 23307005 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Landmark Evidence and Guideline Evolution
  88. [88]

    Kiriyama S, Takada T, Strasberg SM et al.. “TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos).” Journal of hepato-biliary-pancreatic sciences (2013). PMID: 23307001 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Severity Grading and Risk Stratification, Landmark Evidence and Guideline Evolution
  89. [89]

    Yokoe M, Takada T, Strasberg SM et al.. “New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines.” Journal of hepato-biliary-pancreatic sciences (2012). PMID: 22872303 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Severity Grading and Risk Stratification, Landmark Evidence and Guideline Evolution
  90. [90]

    Kiriyama S, Takada T, Strasberg SM et al.. “New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines.” Journal of hepato-biliary-pancreatic sciences (2012). PMID: 22825491 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Severity Grading and Risk Stratification, Landmark Evidence and Guideline Evolution
  91. [91]

    Overdevest AG, Sieswerda E, Haal S et al.. “Antibiotic treatment for 1 day versus 4-7 days in patients with acute cholangitis after adequate endoscopic biliary drainage (COBRA): study protocol for a randomized controlled trial.” Trials (2026). PMID: 41689066 ↗

    L1TRIAL_NONRANDOMCited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Initial Medical Management and Antimicrobial Therapy, Biliary Decompression: Timing and Modalities, Complications and Long-term Outcomes
  92. [92]

    Mayumi T, Takada T, Kawarada Y et al.. “Results of the Tokyo Consensus Meeting Tokyo Guidelines.” Journal of hepato-biliary-pancreatic surgery (2007). PMID: 17252304 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Landmark Evidence and Guideline Evolution
  93. [93]

    Yasuda H, Takada T, Kawarada Y et al.. “Unusual cases of acute cholecystitis and cholangitis: Tokyo Guidelines.” Journal of hepato-biliary-pancreatic surgery (2007). PMID: 17252303 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Landmark Evidence and Guideline Evolution
  94. [94]

    Wada K, Takada T, Kawarada Y et al.. “Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines.” Journal of hepato-biliary-pancreatic surgery (2007). PMID: 17252297 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Landmark Evidence and Guideline Evolution
  95. [95]

    Miura F, Takada T, Kawarada Y et al.. “Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines.” Journal of hepato-biliary-pancreatic surgery (2007). PMID: 17252294 ↗

    L1GUIDELINECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria
  96. [96]

    He YQ, Wang H, Zhao YH et al.. “Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study.” BMC gastroenterology (2024). PMID: 39304833 ↗

    L3CASE_CONTROLCited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria
  97. [97]

    Ucdal M, Ekingen E. “Performance comparison of a neuro-symbolic large language model system versus conventional AI models and human experts in cholangitis management.” BMC medical informatics and decision making (2026). PMID: 42226236 ↗

    L4OTHERCited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria
  98. [98]

    Martínez Márquez RJ, Cienfuegos Alvear JA, Torres Monarrez AA et al.. “Acute cholecystitis and acute cholangitis: the radiologist's role in diagnosis and management.” Abdominal radiology (New York) (2026). PMID: 40728645 ↗

    L5REVIEW_NARRATIVECited in: Tokyo Guidelines 2018 (TG18) Diagnostic Criteria, Laboratory and Radiologic Evaluation
  99. [99]

    Kiriyama S, Kozaka K, Takada T et al.. “Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos).” Journal of hepato-biliary-pancreatic sciences (2018). PMID: 29032610 ↗

    L1SR_OBSCited in: Severity Grading and Risk Stratification
  100. [100]

    Lu ZQ, Zhang HY, Su CF et al.. “Optimal timing of biliary drainage based on the severity of acute cholangitis: A single-center retrospective cohort study.” World journal of gastroenterology (2022). PMID: 36157549 ↗

    L2COHORTCited in: Severity Grading and Risk Stratification
  101. [101]

    Umefune G, Kogure H, Hamada T et al.. “Procalcitonin is a useful biomarker to predict severe acute cholangitis: a single-center prospective study.” Journal of gastroenterology (2017). PMID: 27783206 ↗

    L2COHORTCited in: Severity Grading and Risk Stratification
  102. [102]

    Yokoe M, Hata J, Takada T et al.. “Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).” Journal of hepato-biliary-pancreatic sciences (2018). PMID: 29032636 ↗

    L1REVIEW_NARRATIVECited in: Severity Grading and Risk Stratification
  103. [103]

    Miura F, Okamoto K, Takada T et al.. “Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis.” Journal of hepato-biliary-pancreatic sciences (2018). PMID: 28941329 ↗

    L1REVIEW_NARRATIVECited in: Severity Grading and Risk Stratification
  104. [104]

    Sun G, Han L, Yang Y et al.. “Comparison of two editions of Tokyo guidelines for the management of acute cholangitis.” Journal of hepato-biliary-pancreatic sciences (2014). PMID: 23813895 ↗

    L3OTHERCited in: Severity Grading and Risk Stratification
  105. [105]

    Kiriyama S, Takada T, Hwang TL et al.. “Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study.” Journal of hepato-biliary-pancreatic sciences (2017). PMID: 28419764 ↗

    L3OTHERCited in: Severity Grading and Risk Stratification
  106. [106]

    Sornsenee P, Chaochuensuk C, Sapsong D et al.. “Development and internal validation of a risk stratification scoring system for identifying gram-negative ESBL-positive acute cholangitis: A retrospective cohort study.” PloS one (2026). PMID: 41843577 ↗

    L3COHORTCited in: Severity Grading and Risk Stratification
  107. [107]

    Nakamura A, Watanabe K, Sato W et al.. “Timing of Biliary Drainage and Clinical Outcomes in Acute Cholangitis: A Single-Center Retrospective Cohort Study.” Cureus (2026). PMID: 42005126 ↗

    L3COHORTCited in: Severity Grading and Risk Stratification
  108. [108]

    Hashemi P, Boyer JL, Langdon JH. “The Utility of Elastography in Discriminating Stages of Liver Fibrosis and Risk Stratification in Patients With Primary Sclerosing Cholangitis: A Systematic Review.” Journal of magnetic resonance imaging : JMRI (2026). PMID: 41709322 ↗

    L2SR_OBSCited in: Laboratory and Radiologic Evaluation, Complications and Long-term Outcomes
  109. [109]

    Shah Y, Singh S, Dahiya DS et al.. “Endoscopic Ultrasound-Guided Biliary Drainage for Acute Cholangitis Secondary to Biliary Obstruction: A Systematic Review and Meta-Analysis.” Surgical laparoscopy, endoscopy & percutaneous techniques (2025). PMID: 40548485 ↗

    L1SR_OBSCited in: Laboratory and Radiologic Evaluation, Biliary Decompression: Timing and Modalities
  110. [110]

    Vuppalanchi R, Akisik F, Pansini M et al.. “The Prognostic Utility of Quantitative Magnetic Resonance Cholangiopancreatography in Patients With PSC: A Systematic Review With Structured Evidence Synthesis.” Journal of computer assisted tomography (Unknown). PMID: 41488989 ↗

    L2SR_OBSCited in: Laboratory and Radiologic Evaluation
  111. [111]

    Dupont B, Dejardin O, Kam W et al.. “Impact of timing of access to endoscopic drainage and social determinants of health on the prognosis of patients with periampullary cancer diagnosed through jaundice: a multicenter retrospective study.” Therapeutic advances in gastroenterology (2026). PMID: 41777617 ↗

    L3COHORTCited in: Laboratory and Radiologic Evaluation, Biliary Decompression: Timing and Modalities, Complications and Long-term Outcomes
  112. [112]

    Yang Y, Hou Y, Wang Y et al.. “Diagnostic pitfalls in IgG4-related sclerosing cholangitis presenting as perihilar cholangiocarcinoma: case report with literature review.” Frontiers in immunology (2026). PMID: 42079574 ↗

    L4CASE_REPORTCited in: Laboratory and Radiologic Evaluation
  113. [113]

    Liu YA, Gao X, Gao W et al.. “IgG4-sclerosing cholangitis masquerading as cholangiocarcinoma: a case report of an unresolved preoperative diagnosis.” Frontiers in immunology (2026). PMID: 42004961 ↗

    L4CASE_REPORTCited in: Laboratory and Radiologic Evaluation
  114. [114]

    Lazzari R, Borja Cano M, Rivera Martínez A et al.. “Vibrio fluvialis cholangitis with bacteremia and refractory septic shock: a case report and review of the literature.” Infection (2025). PMID: 40377851 ↗

    L4CASE_REPORTCited in: Laboratory and Radiologic Evaluation, Initial Medical Management and Antimicrobial Therapy
  115. [115]

    Vazzana GF, Romano C, Del Prete S et al.. “Autoimmune liver diseases and overlap syndromes in children with inflammatory bowel diseases.” European journal of pediatrics (2026). PMID: 42035371 ↗

    L5REVIEW_NARRATIVECited in: Laboratory and Radiologic Evaluation
  116. [116]

    Martins A, Reddy A, Dean R et al.. “Gaps in Guideline Adherence for Primary Sclerosing Cholangitis in North America-A 5-Year Analysis.” Liver international : official journal of the International Association for the Study of the Liver (2026). PMID: 41964270 ↗

    L3OTHERCited in: Laboratory and Radiologic Evaluation, Management of Underlying Etiologies
  117. [117]

    Naitoh I, Nakazawa T, Kubota K et al.. “Multicenter Validation Study of the Clinical Diagnostic Criteria for IgG4-Related Sclerosing Cholangitis 2020 in Japan.” Journal of hepato-biliary-pancreatic sciences (2026). PMID: 41500843 ↗

    L3OTHERCited in: Laboratory and Radiologic Evaluation
  118. [118]

    Tanaka A, Treeprasertsuk S, Chang ML et al.. “Autoimmune liver diseases in the Asia Pacific region: proceedings of the autoimmune liver disease course at APASL 2025.” Hepatology international (2026). PMID: 41326940 ↗

    L5REVIEW_NARRATIVECited in: Laboratory and Radiologic Evaluation
  119. [119]

    Cruz Grave E, Chan C, Corwin MT et al.. “Spatial heterogeneity in liver stiffness does not predict clinical outcomes in patients with primary sclerosing cholangitis.” Hepatology communications (2025). PMID: 41099629 ↗

    L3OTHERCited in: Laboratory and Radiologic Evaluation
  120. [120]

    Cristoferi L, Maino C, Bernasconi DP et al.. “Radiomics-Based Prognostication in Primary Sclerosing Cholangitis: A Proof-of-Concept Study.” Liver international : official journal of the International Association for the Study of the Liver (2025). PMID: 41014131 ↗

    L2OTHERCited in: Laboratory and Radiologic Evaluation
  121. [121]

    Levers A, Pantke J, Klimeš F et al.. “Sarcopenia-A Valuable Imaging Biomarker for Disease Progression in Patients With Primary Sclerosing Cholangitis (PSC)?” Liver international : official journal of the International Association for the Study of the Liver (2025). PMID: 40922637 ↗

    L3OTHERCited in: Laboratory and Radiologic Evaluation
  122. [122]

    Altenmüller J, Wiegard C, Sebode M et al.. “Ultrasound for the Detection of Gallbladder Malignancy in Primary Sclerosing Cholangitis.” Liver international : official journal of the International Association for the Study of the Liver (2025). PMID: 40856347 ↗

    L3OTHERCited in: Laboratory and Radiologic Evaluation
  123. [123]

    Kum VTL, Yeung F, Chung PHY et al.. “Cholangitis is associated with liver fibrosis in choledochal malformations.” Journal of pediatric surgery (2026). PMID: 40783022 ↗

    L3OTHERCited in: Laboratory and Radiologic Evaluation
  124. [124]

    Lytvyak E, Hirschfield G, Shreekumar D et al.. “Pathogenesis, Non-Invasive Assessments and Treatment of Hepatic Fibrosis in Autoimmune Liver Diseases.” Liver international : official journal of the International Association for the Study of the Liver (2025). PMID: 40682413 ↗

    L5REVIEW_NARRATIVECited in: Laboratory and Radiologic Evaluation, Biliary Decompression: Timing and Modalities
  125. [125]

    Motor J, Gajewska A, Cienkowski K et al.. “IgG4-related disease - focus on digestive system involvement.” Frontiers in immunology (2025). PMID: 40612937 ↗

    L5REVIEW_NARRATIVECited in: Laboratory and Radiologic Evaluation
  126. [126]

    Naitoh I, Isayama H, Akamatsu N et al.. “The 2024 diagnostic criteria for primary sclerosing cholangitis.” Journal of gastroenterology (2025). PMID: 40504416 ↗

    L1REVIEW_NARRATIVECited in: Laboratory and Radiologic Evaluation
  127. [127]

    Berhane B, van de Put WS, van Rheenen PF. “Gamma-glutamyltransferase testing in paediatric inflammatory bowel disease to screen for primary sclerosing cholangitis: a diagnostic study based on routinely collected electronic healthcare data.” Archives of disease in childhood (2025). PMID: 40412823 ↗

    L2OTHERCited in: Laboratory and Radiologic Evaluation
  128. [128]

    Beuers U, Trampert DC. “IgG4-Related Cholangitis.” Seminars in liver disease (2025). PMID: 40342085 ↗

    L5REVIEW_NARRATIVECited in: Laboratory and Radiologic Evaluation
  129. [129]

    Ippolito D, Maino C, Arrivé L et al.. “ESGAR consensus statement on MR imaging in primary sclerosing cholangitis.” European radiology (2025). PMID: 40285815 ↗

    L1OTHERCited in: Laboratory and Radiologic Evaluation
  130. [130]

    Buhot Q, Bui Q, Chekir H et al.. “MR imaging and cholangiography show suboptimal performance for diagnosing ductal cholangiocarcinoma in primary sclerosing cholangitis patients.” European radiology (2025). PMID: 40285814 ↗

    L3OTHERCited in: Laboratory and Radiologic Evaluation
  131. [131]

    Lee TS, Choi JH, Lee JM et al.. “A randomized non-inferiority trial investigating antibiotic adjustments based on blood culture in acute cholangitis.” Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (2025). PMID: 39880122 ↗

    L1RCTCited in: Initial Medical Management and Antimicrobial Therapy
  132. [132]

    Habib T, Lahoud C, Moussa E et al.. “Prophylactic Antibiotics Reduce Infectious Complications After ERCP in Patients with Suspected Biliary Obstruction: A Meta-Analysis of Randomized Controlled Trials.” Digestive diseases and sciences (2026). PMID: 41134425 ↗

    L1SR_MA_RCTCited in: Initial Medical Management and Antimicrobial Therapy, Biliary Decompression: Timing and Modalities, Complications and Long-term Outcomes
  133. [133]

    Arbabzada N, Dennett L, Meng G et al.. “The Effectiveness of Oral Vancomycin on Inflammatory Bowel Disease in Patients With Primary Sclerosing Cholangitis: A Systematic Review.” Inflammatory bowel diseases (2025). PMID: 39495039 ↗

    L2SR_OBSCited in: Initial Medical Management and Antimicrobial Therapy
  134. [134]

    Bonomi A, Overdevest AG, Busch OR et al.. “Towards a 'step-up approach' for the treatment of recurrent non-stenotic cholangitis after hepaticojejunostomy: systematic review.” HPB : the official journal of the International Hepato Pancreato Biliary Association (2024). PMID: 38906773 ↗

    L4SR_OBSCited in: Initial Medical Management and Antimicrobial Therapy
  135. [135]

    Kaneko J, Takinami M, Anma A et al.. “Clinical Characteristics and Predictors of Acute Cholangitis With Enterococcal-Positive Bile Cultures: A Retrospective Study.” Journal of hepato-biliary-pancreatic sciences (2025). PMID: 40984738 ↗

    L3COHORTCited in: Initial Medical Management and Antimicrobial Therapy, Complications and Long-term Outcomes
  136. [136]

    Brody Y, Slae M, Amir AZ et al.. “Primary antibiotic prophylaxis in biliary atresia did not demonstrate decreased infection rate: Multi-centre retrospective study.” Acta paediatrica (Oslo, Norway : 1992) (2025). PMID: 39528247 ↗

    L3COHORTCited in: Initial Medical Management and Antimicrobial Therapy
  137. [137]

    Masuda S, Imamura Y, Kimura K et al.. “Optimizing short-term antibiotic treatment in patients with acute cholangitis: study protocol for an open-label randomized controlled trial (the BOLT-P3 trial).” Trials (2025). PMID: 40890775 ↗

    L5TRIAL_NONRANDOMCited in: Initial Medical Management and Antimicrobial Therapy, Biliary Decompression: Timing and Modalities
  138. [138]

    Smith E, Wu Y, Adamson C et al.. “Is Antibiotic Prophylaxis Warranted in All Patients With Biliary Obstruction Undergoing Endoscopic Retrograde Cholangiopancreatography?: A Systematic Review and Meta-Analysis.” Journal of clinical gastroenterology (Unknown). PMID: 40961256 ↗

    L1SR_OBSCited in: Initial Medical Management and Antimicrobial Therapy, Biliary Decompression: Timing and Modalities, Complications and Long-term Outcomes
  139. [139]

    García-Marmolejo JP, Diaz-Brochero C, Nocua-Báez LC et al.. “Differences in clinical outcomes according to duration of antibiotic therapy following successful ERCP in patients with acute cholangitis: A retrospective cohort study in Colombia.” Infectious diseases now (2025). PMID: 41176092 ↗

    L3COHORTCited in: Initial Medical Management and Antimicrobial Therapy, Biliary Decompression: Timing and Modalities, Complications and Long-term Outcomes
  140. [140]

    Takai S, Todaka T. “Acute liver failure as a rare presentation of miliary tuberculosis with clinical improvement following prediagnostic corticosteroid therapy: A case report.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 41224108 ↗

    L4CASE_REPORTCited in: Initial Medical Management and Antimicrobial Therapy, Biliary Decompression: Timing and Modalities
  141. [141]

    Kodana M, Imai K, Takayama T et al.. “Acute cholangitis caused by coinfection with zoonotic pathogens of Gallibacterium anatis and Enterococcus cecorum: A case report.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2025). PMID: 39510311 ↗

    L4CASE_REPORTCited in: Initial Medical Management and Antimicrobial Therapy
  142. [142]

    Keshi E, Siemund F, Knitter S et al.. “Differential effects of preoperative cholangitis and biliary stenting in long-term survival of patients undergoing surgery for perihilar cholangiocarcinoma.” European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (2026). PMID: 41672022 ↗

    L3OTHERCited in: Initial Medical Management and Antimicrobial Therapy
  143. [143]

    Satoh T, Takahashi H, Nakatani E et al.. “Impact of Peri-Procedural Antibiotics on Post-ERCP Infectious Adverse Events With Distal Malignant Biliary Obstruction.” Journal of gastroenterology and hepatology (2026). PMID: 41466488 ↗

    L3OTHERCited in: Initial Medical Management and Antimicrobial Therapy, Biliary Decompression: Timing and Modalities
  144. [144]

    Choquet A, Sokal A, Dokmak S et al.. “Recurrent Nonobstructive Cholangitis After Pancreaticoduodenectomy: Prevalence, Risk Factors, and Treatment.” World journal of surgery (2025). PMID: 40776530 ↗

    L3OTHERCited in: Initial Medical Management and Antimicrobial Therapy
  145. [145]

    Cozma MA, Găman MA, Diaconu CC et al.. “Microbial Profile and Antibiotic Resistance Patterns in Bile Aspirates from Patients with Acute Cholangitis: A Multicenter International Study.” Antibiotics (Basel, Switzerland) (2025). PMID: 40723982 ↗

    L2OTHERCited in: Initial Medical Management and Antimicrobial Therapy
  146. [146]

    Fortún J, Rodríguez-Gandía MA, Pintado V et al.. “Oral nonabsorbable antibiotics for prevention of recurrent cholangitis; a brief report study.” Infection (2025). PMID: 39976806 ↗

    L4OTHERCited in: Initial Medical Management and Antimicrobial Therapy
  147. [147]

    Räisänen L, Balouch F, McLaren-Kennedy A et al.. “Outcomes of oral vancomycin therapy in children with atypical ulcerative colitis with or without confirmed primary sclerosing cholangitis: a real-world observational study.” BMJ open gastroenterology (2025). PMID: 39938966 ↗

    L3OTHERCited in: Initial Medical Management and Antimicrobial Therapy
  148. [148]

    Jagtap N, Rughwani H, Talukdar R et al.. “Urgent versus early ERCP in mild-to-moderate acute cholangitis: a randomised controlled trial.” Gut (2026). PMID: 42161575 ↗

    L1RCTCited in: Biliary Decompression: Timing and Modalities, Complications and Long-term Outcomes
  149. [149]

    Peppas S, Suvarnakar A, Abujaber BA et al.. “Endoscopic ultrasound-guided biliary drainage versus endoscopic retrograde cholangiopancreatography biliary drainage in the palliative management of malignant distal biliary obstruction: an updated systematic review and meta-analysis of randomized controlled trials.” Clinical endoscopy (2025). PMID: 40340260 ↗

    L1SR_MA_RCTCited in: Biliary Decompression: Timing and Modalities
  150. [150]

    Gungabissoon U, Hunnicutt J, McDermott EJ et al.. “Pruritus and health-related quality of life in chronic liver disease: a longitudinal, survey-based cohort study.” BMJ open gastroenterology (2025). PMID: 41381205 ↗

    L2COHORTCited in: Biliary Decompression: Timing and Modalities
  151. [151]

    Chittajallu V, Elangovan A, Abu Omar Y et al.. “Biliary endoscopic drainage of septic ICU patients deemed emergent (BEDSIDE): a retrospective cohort study (2012-2022).” BMC gastroenterology (2026). PMID: 42168878 ↗

    L4COHORTCited in: Biliary Decompression: Timing and Modalities, Complications and Long-term Outcomes
  152. [152]

    Liu Z, Wang A, Cao Y et al.. “Case Report: A steroid-sparing mechanical management of IgG4-related sclerosing cholangitis mimicking cholangiocarcinoma.” Frontiers in immunology (2026). PMID: 42112333 ↗

    L4CASE_REPORTCited in: Biliary Decompression: Timing and Modalities, Management of Underlying Etiologies
  153. [153]

    Hsin KH, Tseng HH, Wang HP et al.. “Salvage Endoscopic Management for Basket Impaction Using Cholangioscopy and Electrohydraulic Lithotripsy.” Journal of gastroenterology and hepatology (2025). PMID: 40400219 ↗

    L4CASE_REPORTCited in: Biliary Decompression: Timing and Modalities, Management of Underlying Etiologies
  154. [154]

    Tavakkoli A, Kapinos KA, Kwon RS et al.. “Variations in Incidence and Financial Burdens of Nonpancreatic Postendoscopic Retrograde Cholangiopancreatography Adverse Events.” Clinical and translational gastroenterology (2026). PMID: 41410317 ↗

    L2OTHERCited in: Biliary Decompression: Timing and Modalities
  155. [155]

    He JL, Zhu L, Yang ZZ et al.. “Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography for the Longevous Population.” Clinical interventions in aging (2025). PMID: 41200531 ↗

    L3OTHERCited in: Biliary Decompression: Timing and Modalities
  156. [156]

    Baydoun H, Beran A, Ramai D et al.. “Advanced chronic kidney disease increases the odds of ERCP adverse events but not post-ERCP pancreatitis: a propensity-matched analysis of the US Collaborative Network.” Surgical endoscopy (2026). PMID: 41125933 ↗

    L3OTHERCited in: Biliary Decompression: Timing and Modalities
  157. [157]

    Kongsakon R, Rugivarodom M, Phisalprapa P et al.. “Urgent endoscopic retrograde cholangiopancreatography improves clinical outcomes in acute cholangitis from choledocholithiasis: a propensity score-matched study.” Surgical endoscopy (2025). PMID: 41023220 ↗

    L3OTHERCited in: Biliary Decompression: Timing and Modalities
  158. [158]

    Johnston TM, Lamb CR, Jo A et al.. “Missed opportunities for laparoscopic common bile duct exploration (LCBDE): we can do better.” Surgical endoscopy (2025). PMID: 40935940 ↗

    L4OTHERCited in: Biliary Decompression: Timing and Modalities
  159. [159]

    Xia JY, Komanduri S, Keswani RN et al.. “Integrating multi-omics in bile for biomarker discovery in cholangiocarcinoma.” Hepatology communications (2025). PMID: 40857390 ↗

    L4OTHERCited in: Biliary Decompression: Timing and Modalities
  160. [160]

    Cho E, Park SW, Lee KJ et al.. “Drainage-only strategy on weekend for endoscopic retrograde cholangiopancreatography on the risk of procedure-related adverse events: a prospective observational study.” Therapeutic advances in gastroenterology (2025). PMID: 40821740 ↗

    L2OTHERCited in: Biliary Decompression: Timing and Modalities
  161. [161]

    Sheng Y, Xu S, Zhang S et al.. “The relationship between clinical subtypes, prognosis, and treatment in ICU patients with acute cholangitis using unsupervised machine learning methods.” BMC infectious diseases (2025). PMID: 40760727 ↗

    L2OTHERCited in: Biliary Decompression: Timing and Modalities
  162. [162]

    Volkovetskii V, Lobanova O, Puzyr N et al.. “Laparoscopic common bile duct exploration vs endoscopic retrograde cholangiopancreatography for the treatment of difficult common bile duct stones: postsurgery inflammation and liver function.” Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (2025). PMID: 40683590 ↗

    L3OTHERCited in: Biliary Decompression: Timing and Modalities
  163. [163]

    Mukund A, Choudhury A, Das S et al.. “Salvage PTBD in post living donor liver transplant patients with biliary complications-a single centre retrospective study.” The British journal of radiology (2020). PMID: 31971831 ↗

    L4COHORTCited in: Alternative Decompression: PTBD and Surgical Intervention
  164. [164]

    Moll CF, de Moura DTH, Ribeiro IB et al.. “Endoscopic Biliary Darinage (EBD) versus Percutaneous Transhepatic Biliary Drainage (PTBD) for biliary drainage in patients with Perihilar Cholangiocarcinoma (PCCA): A systematic review and meta-analysis.” Clinics (Sao Paulo, Brazil) (2023). PMID: 36681067 ↗

    L1SR_OBSCited in: Alternative Decompression: PTBD and Surgical Intervention
  165. [165]

    Al Mahjoub A, Menahem B, Fohlen A et al.. “Preoperative Biliary Drainage in Patients with Resectable Perihilar Cholangiocarcinoma: Is Percutaneous Transhepatic Biliary Drainage Safer and More Effective than Endoscopic Biliary Drainage? A Meta-Analysis.” Journal of vascular and interventional radiology : JVIR (2017). PMID: 28343588 ↗

    L2SR_OBSCited in: Alternative Decompression: PTBD and Surgical Intervention
  166. [166]

    Tang Z, Yang Y, Meng W et al.. “Best option for preoperative biliary drainage in Klatskin tumor: A systematic review and meta-analysis.” Medicine (2017). PMID: 29069029 ↗

    L2SR_OBSCited in: Alternative Decompression: PTBD and Surgical Intervention
  167. [167]

    Chen GF, Yu WD, Wang JR et al.. “The methods of preoperative biliary drainage for resectable hilar cholangiocarcinoma patients: A protocol for systematic review and meta analysis.” Medicine (2020). PMID: 32481299 ↗

    L2SR_OBSCited in: Alternative Decompression: PTBD and Surgical Intervention
  168. [168]

    Lynn PB, Warnack EM, Parikh M et al.. “Hemobilia as a Complication of Transhepatic Percutaneous Biliary Drainage: a Rare Indication for Laparoscopic Common Bile Duct Exploration.” Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (2020). PMID: 32607858 ↗

    L4CASE_REPORTCited in: Alternative Decompression: PTBD and Surgical Intervention
  169. [169]

    Shapera E, Ross S, Pattilachan T et al.. “Robotic Biliary Stricturoplasty and Roux-en-Y Hepaticojejunostomy After Hepatic Artery Infusion Pump Injury.” Annals of surgical oncology (2024). PMID: 38632219 ↗

    L4CASE_REPORTCited in: Alternative Decompression: PTBD and Surgical Intervention
  170. [170]

    Tsuchiya T, Sofuni A, Tsuji S et al.. “Endoscopic management of acute cholangitis according to the TG13.” Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (2017). PMID: 28425666 ↗

    L1REVIEW_NARRATIVECited in: Alternative Decompression: PTBD and Surgical Intervention
  171. [171]

    Yonem O, Bayraktar Y. “Clinical characteristics of Caroli's syndrome.” World journal of gastroenterology (2007). PMID: 17461493 ↗

    L5REVIEW_NARRATIVECited in: Alternative Decompression: PTBD and Surgical Intervention
  172. [172]

    Ramchandani M, Pal P, Reddy DN. “Endoscopic management of acute cholangitis as a result of common bile duct stones.” Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (2017). PMID: 28425658 ↗

    L5REVIEW_NARRATIVECited in: Alternative Decompression: PTBD and Surgical Intervention
  173. [173]

    Liao YJ, Lin WT, Tsai HJ et al.. “Critically-Ill Patients with Biliary Obstruction and Cholangitis: Bedside Fluoroscopic-Free Endoscopic Drainage versus Percutaneous Drainage.” Journal of clinical medicine (2022). PMID: 35407477 ↗

    L3OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  174. [174]

    Gupta P, Maralakunte M, Kalra N et al.. “Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis.” Abdominal radiology (New York) (2021). PMID: 33095311 ↗

    L4OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  175. [175]

    Hamada T, Tsujino T, Isayama H et al.. “Percutaneous transhepatic biliary drainage using a ligated catheter for recurrent catheter obstruction: antireflux technique.” Gut and liver (2013). PMID: 23560165 ↗

    L4OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  176. [176]

    Kim JH. “Clinical feasibility and usefulness of CT fluoroscopy-guided percutaneous transhepatic biliary drainage in emergency patients with acute obstructive cholangitis.” Korean journal of radiology (2009). PMID: 19270860 ↗

    L4OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  177. [177]

    Ahn S, Lee YS, Lim KS et al.. “Malignant biliary obstructions: can we predict immediate postprocedural cholangitis after percutaneous biliary drainage?” Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2013). PMID: 23529668 ↗

    L3OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  178. [178]

    Jung HM, Paik J, Lee M et al.. “Clinical Utility of the Tokyo Guidelines 2018 for Acute Cholangitis in the Emergency Department and Comparison with Novel Markers (Neutrophil-to-Lymphocyte and Blood Nitrogen Urea-to-Albumin Ratios).” Journal of clinical medicine (2024). PMID: 38673579 ↗

    L3OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  179. [179]

    Chiu HC, Liu CA, Tseng HS et al.. “Predictors of technical success of percutaneous transhepatic common bile duct stone removal: is it only a matter of stone size?” European radiology (2023). PMID: 37081299 ↗

    L3OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  180. [180]

    O'Brien S, Bhutiani N, Egger ME et al.. “Comparing the efficacy of initial percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography with stenting for relief of biliary obstruction in unresectable cholangiocarcinoma.” Surgical endoscopy (2020). PMID: 31139984 ↗

    L3OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  181. [181]

    Kim KM, Park JW, Lee JK et al.. “A Comparison of Preoperative Biliary Drainage Methods for Perihilar Cholangiocarcinoma: Endoscopic versus Percutaneous Transhepatic Biliary Drainage.” Gut and liver (2015). PMID: 26087784 ↗

    L3OTHERCited in: Alternative Decompression: PTBD and Surgical Intervention
  182. [182]

    Grikyte I, Ignatavicius P. “Risk assessment of gallbladder cancer in patients with primary sclerosing cholangitis and gallbladder polyps: a systematic review.” Langenbeck's archives of surgery (2025). PMID: 40632214 ↗

    L3SR_OBSCited in: Management of Underlying Etiologies
  183. [183]

    Bejaoui I, Maatouk M, Kbir GH et al.. “Is Laparoscopic Common Bile Duct Exploration Safe in Patients with Acute Cholangitis Caused by Common Bile Duct Stones? Results of a Systematic Review.” Journal of laparoendoscopic & advanced surgical techniques. Part A (2025). PMID: 39761129 ↗

    L2SR_OBSCited in: Management of Underlying Etiologies
  184. [184]

    Liao Y, Liu F, Zhang X et al.. “The safety and efficacy of primary duct closure after laparoscopic common bile duct exploration in patients with mild-to-moderate calculus-associated acute cholangitis: a retrospective cohort study.” Updates in surgery (2024). PMID: 39581941 ↗

    L3COHORTCited in: Management of Underlying Etiologies
  185. [185]

    Escobar JC, Pereyra MN, Abbass MA. “Primary Sclerosing Cholangitis and Inflammatory Bowel Disease.” The Surgical clinics of North America (2025). PMID: 40015822 ↗

    L5REVIEW_NARRATIVECited in: Management of Underlying Etiologies
  186. [186]

    Cançado GGL, Deeb M, Gulamhusein AF. “Liver transplantation for cholestatic liver diseases: Timing and disease recurrence.” Hepatology (Baltimore, Md.) (2025). PMID: 39960305 ↗

    L5REVIEW_NARRATIVECited in: Management of Underlying Etiologies
  187. [187]

    Guilabert L, Cárdenas-Jaén K, de-Madaria E. “Initial Management of Acute Pancreatitis.” Gastroenterology clinics of North America (2025). PMID: 39880529 ↗

    L5REVIEW_NARRATIVECited in: Management of Underlying Etiologies
  188. [188]

    Masuda S, Imamura Y, Jinushi R et al.. “Navigating antibiotic therapy in acute cholangitis: Best practices and new insights.” Journal of hepato-biliary-pancreatic sciences (2025). PMID: 39537571 ↗

    L5REVIEW_NARRATIVECited in: Management of Underlying Etiologies
  189. [189]

    Izumi H, Yoshii H, Fujino R et al.. “The usefulness of percutaneous bile duct metal stent insertion for malignant biliary obstruction: a retrospective study.” BMC gastroenterology (2025). PMID: 40165110 ↗

    L3COHORTCited in: Management of Underlying Etiologies
  190. [190]

    Zhang X, Zhang L, Zhao S et al.. “Tumor marker pseudoprogression and immune-related cholangitis during conversion therapy for massive hepatocellular carcinoma: a case report.” Frontiers in immunology (2025). PMID: 40534866 ↗

    L4CASE_REPORTCited in: Management of Underlying Etiologies
  191. [191]

    Khan R, Marchena-Romero KJ, Ismail MF et al.. “On-site ERCP availability and cholangitis outcomes: Retrospective cohort study.” Endoscopy international open (2025). PMID: 39958657 ↗

    L3COHORTCited in: Management of Underlying Etiologies
  192. [192]

    Massironi S, Fanizzi F, Invernizzi F et al.. “Inflammatory bowel disease and primary sclerosing cholangitis: immunological links and clinical outlook.” Expert review of clinical immunology (2026). PMID: 42017751 ↗

    L5REVIEW_NARRATIVECited in: Management of Underlying Etiologies
  193. [193]

    Zhang L, Huang J, Liu Q et al.. “Secondary choledocholithiasis caused by fish bones: a case report and review of the literature.” Journal of medical case reports (2025). PMID: 41327345 ↗

    L4CASE_REPORTCited in: Management of Underlying Etiologies
  194. [194]

    Veyre F, Francoz C, Erard D et al.. “Graft and Patient Survival After Liver Transplantation for Primary Sclerosing Cholangitis: A French National Cohort Study.” Liver international : official journal of the International Association for the Study of the Liver (2026). PMID: 41816929 ↗

    L3COHORTCited in: Complications and Long-term Outcomes
  195. [195]

    Ar E, Solomonidou I, Lenzen H et al.. “Long-term clinical and endoscopic outcomes of ulcerative colitis after liver transplantation: a multicenter cohort study on the use and safety of advanced therapies.” Inflammatory bowel diseases (2026). PMID: 41615920 ↗

    L3COHORTCited in: Complications and Long-term Outcomes
  196. [196]

    D'Amico F, Allocca M, Lusetti F et al.. “Primary Sclerosing Cholangitis Worsens Prognosis in Patients With Inflammatory Bowel Disease: A Propensity-Matched Cohort Study.” United European gastroenterology journal (2025). PMID: 40920341 ↗

    L3COHORTCited in: Complications and Long-term Outcomes
  197. [197]

    Liu F, Gu DJ, Pan J et al.. “Validation of the safety of primary laparoscopic common bile duct closure in acute cholangitis: a retrospective cohort study.” BMC surgery (2026). PMID: 41629855 ↗

    L3COHORTCited in: Complications and Long-term Outcomes
  198. [198]

    Liu J, Song Y, Zhang D et al.. “Sex differences in the association between red cell distribution width and 30-day mortality in critically ill patients with acute cholangitis: a retrospective cohort study.” BMC gastroenterology (2025). PMID: 41419799 ↗

    L3COHORTCited in: Complications and Long-term Outcomes
  199. [199]

    Afonso AB, da Silva CM, Nogueira P et al.. “Meta-Analysis: Comparison of Living Versus Deceased Liver Transplantation for Primary Sclerosing Cholangitis.” Alimentary pharmacology & therapeutics (2025). PMID: 40890931 ↗

    L2SR_OBSCited in: Complications and Long-term Outcomes
  200. [200]

    Díaz-González Á, Molera C, Gómez-Domínguez E et al.. “Spanish clinical practice guidelines for the diagnosis and management of cholestatic liver diseases in adult and pediatric population: Joint report from AEEH and SEGHNP.” Gastroenterologia y hepatologia (2026). PMID: 41232665 ↗

    L1GUIDELINECited in: Complications and Long-term Outcomes
  201. [201]

    Manes G, Paspatis G, Aabakken L et al.. “Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline.” Endoscopy (2019). PMID: 30943551 ↗

    L1GUIDELINECited in: Landmark Evidence and Guideline Evolution
  202. [202]

    Miura F, Takada T, Strasberg SM et al.. “TG13 flowchart for the management of acute cholangitis and cholecystitis.” Journal of hepato-biliary-pancreatic sciences (2013). PMID: 23307003 ↗

    L1GUIDELINECited in: Landmark Evidence and Guideline Evolution
  203. [203]

    Takada T, Strasberg SM, Solomkin JS et al.. “TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis.” Journal of hepato-biliary-pancreatic sciences (2013). PMID: 23307006 ↗

    L1GUIDELINECited in: Landmark Evidence and Guideline Evolution
  204. [204]

    Itoi T, Tsuyuguchi T, Takada T et al.. “TG13 indications and techniques for biliary drainage in acute cholangitis (with videos).” Journal of hepato-biliary-pancreatic sciences (2013). PMID: 23307008 ↗

    L1GUIDELINECited in: Landmark Evidence and Guideline Evolution
  205. [205]

    Okamoto K, Takada T, Strasberg SM et al.. “TG13 management bundles for acute cholangitis and cholecystitis.” Journal of hepato-biliary-pancreatic sciences (2013). PMID: 23307002 ↗

    L1GUIDELINECited in: Landmark Evidence and Guideline Evolution
  206. [206]

    Gomi H, Solomkin JS, Takada T et al.. “TG13 antimicrobial therapy for acute cholangitis and cholecystitis.” Journal of hepato-biliary-pancreatic sciences (2013). PMID: 23340954 ↗

    L1GUIDELINECited in: Landmark Evidence and Guideline Evolution
  207. [207]

    Kimura Y, Takada T, Kawarada Y et al.. “Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines.” Journal of hepato-biliary-pancreatic surgery (2007). PMID: 17252293 ↗

    L1GUIDELINECited in: Landmark Evidence and Guideline Evolution

Revision History

All updates applied to this page

Loading revisions…