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Although most cases respond to antibiotics alone, definitive therapy is required later in most of the patients. Increased biliary pressure leads to biliovenous reflux of bacteria and purulent bile into the circulation leading to systemic inflammation and sepsis with subsequent organ dysfunction. Biliary decompression increases antibiotic penetration in bile. Therefore, patients with high\u2010risk factors and organ dysfunction require early and urgent biliary drainage, respectively, as they are unlikely to respond with antibiotics alone. Biliary decompression is best achieved by endoscopic retrograde cholangiopancreatography (<jats:styled-content style=\"fixed-case\">ERCP<\/jats:styled-content>) compared to percutaneous and surgical decompression. <jats:styled-content style=\"fixed-case\">ERCP<\/jats:styled-content> can be technically difficult and sometimes unsuccessful especially in patients with altered anatomy and upper gastrointestinal obstruction. Earlier percutaneous transhepatic biliary drainage (<jats:styled-content style=\"fixed-case\">PTBD<\/jats:styled-content>) and surgery were the only viable options in those patients. <jats:styled-content style=\"fixed-case\">PTBD<\/jats:styled-content> requires a dilated biliary system, is more invasive and cannot achieve ductal clearance in cholangitis as a result of choledocholithiasis, whereas surgery is associated with high morbidity and mortality. Advances in therapeutic endoscopy such as balloon enteroscopy\u2010guided biliary drainage or endoscopic ultrasound guided\u2010biliary drainage have added new dimensions to endoscopic management of acute cholangitis as a result of choledocholithiasis obviating the need for more invasive procedures.<\/jats:p>","DOI":"10.1111\/den.12848","type":"journal-article","created":{"date-parts":[[2017,4,20]],"date-time":"2017-04-20T10:08:53Z","timestamp":1492682933000},"page":"78-87","source":"Crossref","is-referenced-by-count":26,"title":["Endoscopic management of acute cholangitis as a result of common bile duct stones"],"prefix":"10.1111","volume":"29","author":[{"given":"Mohan","family":"Ramchandani","sequence":"first","affiliation":[{"name":"Department of Medical Gastroenterology Asian Institute of Gastroenterology Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Partha","family":"Pal","sequence":"additional","affiliation":[{"name":"Department of Medical Gastroenterology Asian Institute of Gastroenterology Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D Nageshwar","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Medical Gastroenterology Asian Institute of Gastroenterology Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-006-1156-7"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1982.01380280031007"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198904000-00008"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(05)80930-4"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.15406\/ghoa.2016.05.00133"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2008.03.001"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-006-1156-7"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-010-0338-5"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-012-0537-3"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(97)70237-2"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2005.12.038"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(98)70242-1"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(95)70096-X"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.1.118"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2005.41057.x"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.180.2.1800467"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.181.1.1810115"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.176.3.1760675"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2001.04045.x"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2009.126"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/25.3.399"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-006-1157-6"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1067\/mge.2002.122334"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.03.029"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2001.01071.x"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199206113262401"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(02)70039-4"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-861054"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2008.04.025"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.08.009"},{"key":"e_1_2_10_32_1","first-page":"233","article-title":"Endoscopic sphincterotomy and biliary drainage in patients with cholangitis due to common bile duct stones","volume":"90","author":"Boender J","year":"1995","journal-title":"Am. 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