title: Safety of immediate endoscopic sphincterotomy in acute suppurative cholangitis caused by choledocholithiasis.
abstract: OBJECTIVE
  To examine the safety of immediate endoscopic sphincterotomy (EST) in patients with acute suppurative cholangitis (ASC) caused by choledocholithiasis, as compared with elective EST.
  
  
  METHODS
  Patients with ASC due to choledocholithiasis were allocated to two groups: Those who underwent EST immediately and those who underwent EBD followed by EST 1 wk later because they were under anticoagulant therapy, had a coagulopathy (international normalized ratio > 1.3, partial thromboplastin time greater than twice that of control), or had a platelet count < 50000 × 10(3)/μL. One of four trainees [200-400 cases of endoscopic retrograde cholangiopancreatography (ERCP)] supervised by a specialist (> 10000 cases of ERCP) performed the procedures. The success and complication rates associated with EST in each group were examined.
  
  
  RESULTS
  Of the 87 patients with ASC, 59 were in the immediate EST group and 28 in the elective EST group. EST was successful in all patients in both groups. There were no complications associated with EST in either group of patients, although white blood cell count, C-reactive protein, total bilirubin, and serum concentrations of liver enzymes just before EST were significantly higher in the immediate EST group than in the elective EST group.
  
  
  CONCLUSIONS
  Immediate EST can be as safe as elective EST for patients with ASC associated with choledocholithiasis provided they are not under anticoagulant therapy, or do not have a coagulopathy or a platelet count < 50000 × 10(3)/μL. Moreover, the procedure was safely performed by a trainee under the supervision of an experienced specialist.
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Tomoyasu
authors: T
authors: Ito
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Jin Kan
authors: JK
authors: Sai
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Hironao
authors: H
authors: Okubo
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Hiroaki
authors: H
authors: Saito
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Shigeto
authors: S
authors: Ishii
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Ryo
authors: R
authors: Kanazawa
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Ko
authors: K
authors: Tomishima
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Sumio
authors: S
authors: Watanabe
authors: Tomoyasu Ito, Jin Kan Sai, Hiroaki Saito, Shigeto Ishii, Ryo Kanazawa, Ko Tomishima, Sumio Watanabe, Shuichiro Shiina, Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors: Shuichiro
authors: S
authors: Shiina
keywords: Acute cholangitis; Complications; Endoscopic sphincterotomy