The Comparisons of One-stage Stone Removal in Mild and Moderate Cholangitis
The Comparisons of One-stage Stone Removal in Mild and Moderate Cholangitis
In expert comment, performing the sphincterotomy for choledocholithiasis with acute
 cholangitis may increase bleeding and pancreatitis risks (from 2% to 10%). Therefore,
 investigators often perform biliary drainage in acute stage, and arrange 2nd session ERCP for
 stone removal later. However, in the recent study, single-stage endoscopic treatment may be
 still effective (stone removal rate 90%) and safe for mild to moderate acute cholangitis
 associated with choledocholithiasis. Investigators will carry out a prospective trial to
 analyze one-stage retrograde endoscopic common bile duct stone removal in mild and moderate
 cholangitis with choledocholithiasis to determine the safety, successful rate, and
 complications in these two groups.
Investigators will enroll 204 naïve papilla with a body temperature ≥37 °C who was diagnosed
 with mild to moderate cholangitis associated with choledocholithiasis. The method of
 one-stage: performing the stone removal at the first session of ERCP. The pancreas duct stent
 will be placed for preventing post ERCP pancreatitis (PEP) if necessary. The indomethacin
 100mg anal route will be administered for all patients without allergy history. All
 participants will receive the empiric antibiotics treatment for cholangitis.
Inclusion Criteria:

 -  naïve papilla with a body temperature ≥37 °C who was diagnosed with mild to moderate
 cholangitis associated with choledocholithiasis.

 Exclusion Criteria:

 -  procedural failure requiring an anatomy-modifying procedure, such as a Billroth II
 subtotal gastrectomy or R-en-Y gastrojejunostomy ;

 -  stenosis of the pyloric ring ;

 -  tumor-related obstruction;

 -  failure to locate the papilla ;

 -  active peptic ulcer bleeding ;

 -  intolerance due to inadequate sedation

 -  CBD sludge;

 -  non-naïve papilla in ERCP