Tokyo guideline 2013 ((TG13)) is an international guideline for the diagnosis, classification and treatment of Acute cholangitis. Progress and controversy for the two years after TG13 was summarized. endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are both effective imaging tests for common bile duct (CBD) stones. More factors e.g. obesity may be involved in severity assessment. Initiation of broad-spectrum antibiotics addressing the typical Gram-negative enteric bacteria spectrum and early biliary drainage are the mainstay therapeutic options. Early laparoscopic exploration is also an option for stone-related nonsevere acute cholangitis besides endoscopic retrograde cholangial or p(ERC)utaneous transhepatic cholangial drainage. Surgical biliary drainage should be avoided in severe cholangitis.

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