Background: Endoscopic drainage of the biliary tree for acute cholangitis is a therapeutic modality with a lower mortality and complication rates. Aim: To compare endoscopic drainage with surgical treatment in the emergency management of acute cholangitis. Patients and methods: Between 1995 and 1998, sixty five patients with acute cholangitis were subjected to an endoscopic drainage of the biliary tree. In the same period, 40 patients were treated with traditional surgical procedures. The evolution of both groups of patients were compared. Results: Sixty two patients (95.4%) subjected to endoscopic treatment had a satisfactory evolution, compared with 23 (58%) of those operated (p <0.001). Five operated patients and no individual subjected to endoscopic drainage died (p <0.01). Mean postoperative hospital stay of operated patients was 15.5 ± 19.6 days compared to 5.8 ± 4.2 days in those subjected to endoscopic drainage (p <0.001). Definitive resolution of biliary obstruction was achieved in 83% of patients subjected to endoscopic drainage or traditional surgery. Conclusions: Endoscopic drainage has a lower rate of complications and mortality than traditional surgery, in the treatment of acute cholangitis. (Rev Méd Chile 2001; 753-62)