Acute cholangitis

Refer patients with primary sclerosing cholangitis (PSC) to a hepatologist for formal evaluation and possible consideration for liver transplantation depending on the severity of disease and model for end-stage liver disease score. The long-term endoscopic management of PSC is complex and individualised, but often includes frequent endoscopic retrograde cholangiopancreatography with tissue sampling to rule out cholangiocarcinoma and the use of balloon dilations and stents to manage symptomatic obstructing bile duct strictures.

Patients who develop cholangitis due to choledocholithiasis and undergo stone removal from the biliary tree with subsequent cholecystectomy are at low risk of recurrent cholangitis and can be followed expectantly.

Patients with HIV cholangiopathy who undergo sphincterotomy should be followed for improvement in liver chemistries and symptoms and should be referred to an HIV specialist for long-term care.