MULTIMODAL MANAGEMENT OF BENIGN OBSTRUCTIVE JAUNDICE: A SYNTHESIS OF CURRENT EVIDENCE

Ion Cotoneț; Adrian Hotineanu; Alexandru Ferdohleb

doi:10.5281/zenodo.23268508

Authors

Ion Cotoneț Department of Surgery no. 2, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova https://orcid.org/0000-0002-2637-4671
Adrian Hotineanu Department of Surgery no. 2, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
Alexandru Ferdohleb Department of Surgery no. 2, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova https://orcid.org/0000-0003-3290-8139

DOI:

https://doi.org/10.5281/zenodo.23268508

Keywords:

benign obstructive jaundice, choledocholithiasis, endoscopic retrograde cholangiopancreatography, acute cholangitis, quality of life

Abstract

Objectives. To synthesise contemporary evidence on triage, risk stratification and combined therapeutic strategies in benign obstructive jaundice, and to formulate a set of practical desiderata adaptable to the resource context of the Republic of Moldova.

Methods. Structured narrative review of the literature published between January 2010 and August 2026, searching PubMed/MEDLINE, Embase and the Cochrane Library. Professional society guidelines, Cochrane systematic reviews, meta-analyses, randomised controlled trials and external guideline validation studies were prioritised. Reference protocols were compared on the points where their recommendations diverge.

Results. The Tokyo Guidelines TG18 remain the most widely validated triage instrument for acute cholangitis, and biliary drainage performed within the first 48 hours is associated with lower in-hospital mortality (OR 0.52; 95% CI: 0.28–0.98). The ASGE and ESGE criteria show modest discriminative power in high-risk patients, their principal strength lying in ruling out choledocholithiasis in low-risk patients. Selective biliary cannulation fails in 5–15% of procedures, an intradiverticular papilla reducing the success rate to 80.1% compared with 88.7% in the absence of a diverticulum. Primary closure of the choledochotomy is associated with fewer retained stones (OR 0.57), less biliary peritonitis (OR 0.22), and shorter operative time and hospital stay. Cholecystectomy performed within 72 hours of endoscopic clearance reduces conversion to open surgery (RR 0.35) and recurrent biliary events (RR 0.09).

Conclusions. Contemporary management of benign obstructive jaundice requires rigorous triage, dynamic stratification of operative risk and sequential integration of therapeutic components. In centres where the necessary infrastructure and expertise are already available, the desiderata with the largest demonstrated effect depend mainly on the organisation of the patient pathway.