Biliary tract emergencies. Endoscopic and medical management.

The application of therapeutic ERCP and interventional radiology has significantly altered the treatment of biliary tract emergencies. Although surgery is the principal treatment for acute cholecystitis, nonoperative alternatives exist for high-risk patients. New, prospective, randomized trials have demonstrated that endoscopic management of severe cholangitis is superior to surgery, and that endoscopic sphincterotomy and stone extraction are superior to conservative treatment in severe gallstone pancreatitis. ERCP allows nonoperative management of postoperative bile leaks as well.