Tokyoguideline2013((TG13)) is an international guideline for the diagnosis, classification and treatment ofAcutecholangitis. Progress and controversy for the two years after TG13 was summarized.endoscopicultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are both effective imaging tests forcommonbileduct(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. Earlylaparoscopicexplorationis also an option for stone-related nonsevere acute cholangitis besides endoscopicretrogradecholangial or p(ERC)utaneoustranshepaticcholangial drainage. Surgical biliary drainage should be avoided in severe cholangitis.

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