title: Endoscopic management of cholangitis: critical review of an alternative technique and report of a large series.
abstract: OBJECTIVE
  To assess the outcome of endoscopic techniques as the solitary treatment modality for the complete management of ascending, bacterial cholangitis, compared with results of radiological and surgical methods as historical controls.
  
  
  METHODS
  Endoscopic techniques were used to decompress bile ducts obstructed by stones (898 patients) or stenosis (49 patients). Endoscopic sphincterotomy (ES) was performed in 839 patients, and either 7-Fr straight stents (79), or nasobiliary tubes (29), were utilized as initial therapy in 108 patients. Of these latter patients, 68 subsequently underwent ES and stone removal, 17 had ES, lithotripsy, and stone removal, 18 were left with stents in place, and 5 were lost to follow-up. Follow-up was conducted by direct patient contact, by telephone, or through the referring physicians.
  
  
  RESULTS
  All patients were managed by endoscopic techniques. There were four deaths (0.42%) in the first 30 days (none before 2 wk); no deaths were related to the procedures but were attributed to intercurrent medical problems. Two patients underwent surgery: one pancreatitis, one perforation. Complications were infrequent, occurring in 6% of patients. Bleeding occurred in 3%, pancreatitis in 2.8%, and perforation 0.2%.
  
  
  CONCLUSIONS
  Endoscopic management of cholangitis is as effective as surgical or radiological methods for managing bacterial cholangitis, a potentially fatal syndrome, but ERCP and ES have been shown to be safer. Endoscopy is the preferred index technique both for establishing a definitive diagnosis and providing therapy.
authors.affiliation: Department of Medicine, Beth Israel Medical Center, New York, NY.
authors.forename: J H
authors.initials: JH
authors.lastname: Siegel
authors.forename: R
authors.initials: R
authors.lastname: Rodriquez
authors.forename: S A
authors.initials: SA
authors.lastname: Cohen
authors.forename: F E
authors.initials: FE
authors.lastname: Kasmin
authors.forename: A M
authors.initials: AM
authors.lastname: Cooperman
mesh_terms: D000368:Aged; D000465:Algorithms; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D007440:Intubation; D008297:Male; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D016896:Treatment Outcome