{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:24:50Z","timestamp":1783113890117,"version":"3.54.6"},"reference-count":39,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011892","name":"Kaohsiung Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG8H0341"],"award-info":[{"award-number":["CMRPG8H0341"]}],"id":[{"id":"10.13039\/501100011892","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Evidence supporting the feasibility of single-stage stone removal in patients with a moderate grade of acute cholangitis remains insufficient. The maximal size of a common bile-duct stone suitable for removal during a single-stage ERCP in a moderate grade of acute cholangitis is unknown. Methods: We prospectively enrolled 196 endoscopic retrograde cholangiopancreatography (ERCP)-na\u00efve patients diagnosed with acute cholangitis and choledocholithiasis. For eligible patients, single-stage treatment involved stone removal at initial ERCP. Results: A total of 123 patients were included in the final analysis. The success rate of complete stone extraction was similar between patients with mild and moderate grades of acute cholangitis (89.2% vs. 95.9%; p = 0. 181). Complication rates were comparable between the two groups. In the moderate grade of the cholangitis group, among patients who underwent early single-stage ERCP, the length of hospitalization declined as short as the patients in the mild grade of cholangitis (10.6 \u00b1 6.2 vs. 10.1 \u00b1 5.1 days; p = 0.408). In the multivariate analysis, early ERCP indicated shorter hospitalization times (\u226410 days) (odds ratio (OR), 3.981; p = 0.001). A stone size less than 1.5 cm presented a high success rate (98.0%) for complete stone removal. Conclusions: Single-stage retrograde endoscopic stone removal in mild and moderate grades of acute cholangitis may be safe and effective, which can obviate the requirement for a second session, thus reducing medical expenses. ClinicalTrials.gov: NCT03754491.<\/jats:p>","DOI":"10.3390\/life12122000","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T07:38:50Z","timestamp":1669793930000},"page":"2000","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Early and Direct Endoscopic Stone Removal in the Moderate Grade of Acute Cholangitis with Choledocholithiasis Was Safe and Effective: A Prospective Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6614-5937","authenticated-orcid":false,"given":"Chih-Ming","family":"Liang","sequence":"first","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"},{"name":"Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chun","family":"Chiu","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"},{"name":"Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lung-Sheng","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4105-4913","authenticated-orcid":false,"given":"Cheng-Kun","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"},{"name":"Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fai-Meng","family":"Sou","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Ming","family":"Chiu","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chi","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6666-944X","authenticated-orcid":false,"given":"Pao-Yuan","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8934-3223","authenticated-orcid":false,"given":"Seng-Kee","family":"Chuah","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"},{"name":"Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Mou","family":"Kuo","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"},{"name":"Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s00534-012-0564-0","article-title":"TG13 current terminology, etiology, and epidemi ology of acute cholangitis and cholecystitis","volume":"20","author":"Kimura","year":"2013","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.giec.2007.03.006","article-title":"Management of Ascending Cholangitis","volume":"17","author":"Kinney","year":"2007","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0140-6736(96)06316-7","article-title":"Randomised study of endoscopic biliary endoprosthesis versus duct clearance for bileduct stones in high-risk patients","volume":"348","author":"Chopra","year":"1996","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e97","DOI":"10.1097\/MCG.0000000000000982","article-title":"Outcomes Associated With Timing of ERCP in Acute Cholangitis Secondary to Choledocholithiasis","volume":"52","author":"Parikh","year":"2018","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.gie.2011.04.012","article-title":"ASGE Standards of Practice Committee: The role of endoscopy in the management of choledocholithiasis","volume":"74","author":"Maple","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s00534-012-0563-1","article-title":"TG13 flowchart for the management of acute cholangitis and cholecystitis","volume":"20","author":"Miura","year":"2013","journal-title":"J. Hepato-Biliary-Pancreatic Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"180","DOI":"10.4253\/wjge.v8.i3.180","article-title":"Safety of immediate endoscopic sphincterotomy in acute suppurative cholangitis caused by choledocholithiasis","volume":"8","author":"Ito","year":"2016","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1002\/jhbp.296","article-title":"Single-stage endoscopic treatment for mild to moderate acute cholangitis associated with choledocholithiasis: A multicenter, non-randomized, open-label and exploratory clinical trial","volume":"22","author":"Eto","year":"2015","journal-title":"J. Hepato-Biliary-Pancreatic Sci."},{"key":"ref_9","first-page":"2082","article-title":"Management for CBD Stone-Related Mild to Moderate Acute Cholangitis: Urgent Versus Elective ERCP","volume":"58","author":"Jang","year":"2013","journal-title":"Am. J. Dig. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1002\/aid2.13173","article-title":"Single-stage retrograde endoscopic common bile duct stone removal might be sufficient in moderate acute cholangitis with a stone size \u226412 mm: A retrospective cohort study with propensity score matching","volume":"7","author":"Hung","year":"2020","journal-title":"Adv. Dig. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3145107","DOI":"10.1155\/2018\/3145107","article-title":"Efficacy and Safety of Single-Session Endoscopic Stone Removal for Acute Cholangitis Associated with Choledocholithiasis","volume":"2018","author":"Sato","year":"2018","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/jhbp.509","article-title":"Tokyo Guidelines 2018: Initial management of acute biliary infection and flowchart for acute cholangitis","volume":"25","author":"Miura","year":"2018","journal-title":"J. Hepato-Biliary-Pancreatic Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1007\/s00534-012-0537-3","article-title":"New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines","volume":"19","author":"Kiriyama","year":"2012","journal-title":"J. Hepato-Biliary-Pancreatic Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1097\/MCG.0b013e3182617a42","article-title":"Endoscopic papillary balloon dilation for removal of bile duct stones: Evaluation of outcomes and complications in 298 patients","volume":"46","author":"Kuo","year":"2012","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12876-016-0486-4","article-title":"Limited precut sphincterotomy combined with endoscopic papillary balloon dilation for common bile duct stone removal in patients with difficult biliary cannulation","volume":"16","author":"Kuo","year":"2016","journal-title":"BMC Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1055\/s-0034-1377875","article-title":"Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline\u2014Updated June 2014","volume":"46","author":"Dumonceau","year":"2014","journal-title":"Endoscopy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1055\/s-0043-122386","article-title":"Aggressive intravenous hydration with lactated Ringer\u2019s solution for prevention of post-ERCP pancreatitis: A prospective randomized multicenter clinical trial","volume":"50","author":"Park","year":"2018","journal-title":"Endoscopy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1177\/2050640616674837","article-title":"Results of an inter- and intraobserver agreement study","volume":"5","author":"Haraldsson","year":"2017","journal-title":"U Eur. Gastroenterol. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s12876-019-1017-x","article-title":"The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones","volume":"19","author":"Kuo","year":"2019","journal-title":"BMC Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"7597","DOI":"10.3748\/wjg.v27.i44.7597","article-title":"Endoscopic management of difficult common bile duct stones: Where are we now? A comprehensive review","volume":"27","author":"Tringali","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Bursac","year":"2008","journal-title":"Source Code Biol. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A lexicon for endoscopic adverse events: Report of an ASGE workshop","volume":"71","author":"Cotton","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1056\/NEJM199609263351301","article-title":"Complications of Endoscopic Biliary Sphincterotomy","volume":"335","author":"Freeman","year":"1996","journal-title":"New Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.cgh.2012.05.017","article-title":"Balloon Dilation With Adequate Duration Is Safer Than Sphincterotomy for Extracting Bile Duct Stones: A Systematic Review and Meta-analyses","volume":"10","author":"Liao","year":"2012","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1111\/j.1572-0241.1998.00593.x","article-title":"The benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis","volume":"93","author":"Sugiyama","year":"1998","journal-title":"Am. J. Gastroenterol."},{"key":"ref_26","first-page":"233","article-title":"Endoscopic sphincterotomy and biliary drainage in patients with cholangitis due to common bile duct stones","volume":"90","author":"Boender","year":"1995","journal-title":"Am. J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E103","DOI":"10.1055\/s-0042-120412","article-title":"Sphincterotomy with endoscopic biliary drainage for severe acute cholangitis: A meta-analysis","volume":"5","author":"Sawas","year":"2017","journal-title":"Endosc. Int. Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e16529","DOI":"10.1097\/MD.0000000000016529","article-title":"Endoscopic papillary balloon dilation decreases the risk of bleeding in cirrhotic patients compared with endoscopic biliary sphincterotomy: A national population-based study","volume":"98","author":"Hung","year":"2019","journal-title":"Medicine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1067\/S0016-5107(03)01871-6","article-title":"Does the addition of endoscopic sphincterotomy to stent insertion improve drainage of the bile duct in acute suppurative cholangitis?","volume":"58","author":"Hui","year":"2003","journal-title":"Gastrointest. Endosc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2495","DOI":"10.1007\/s00464-018-6537-x","article-title":"Optimum timing of emergency cholecystectomy for acute cholecystitis in England: Population-based cohort study","volume":"33","author":"Wiggins","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1007\/s11605-015-2909-x","article-title":"Acute Cholecystitis\u2014Optimal Timing for Early Cholecystectomy: A French Nationwide Study","volume":"19","author":"Polo","year":"2015","journal-title":"J. Gastrointest. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1001\/jamasurg.2014.2339","article-title":"Optimal Time for Early Laparoscopic Cholecystectomy for Acute Cholecystitis","volume":"150","author":"Zafar","year":"2015","journal-title":"JAMA Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/jac\/32.suppl_A.69","article-title":"Foreign body associated infection","volume":"32","author":"Jansen","year":"1993","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_34","first-page":"97","article-title":"Pathogenesis of cholangitis in obstructive jaundice-revisited","volume":"57","author":"Navaneethan","year":"2011","journal-title":"Minerva Gastroenterol. e Dietol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1136\/gut.2004.043059","article-title":"Bacterial biofilm within diseased pancreatic and biliary tracts","volume":"54","author":"Swidsinski","year":"2005","journal-title":"Gut"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/jhbp.518","article-title":"Tokyo Guidelines 2018: Antimicrobial therapy for acute cholangitis and cholecystitis","volume":"25","author":"Gomi","year":"2018","journal-title":"J. Hepato-Biliary-Pancreatic Sci."},{"key":"ref_37","first-page":"4128","article-title":"Antibiotic Therapy of 3 Days May Be Sufficient After Biliary Drainage for Acute Cholangitis: A Systematic Review","volume":"66","author":"Haal","year":"2021","journal-title":"Am. J. Dig. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.gie.2007.04.033","article-title":"Factors influencing the technical difficulty of endoscopic clearance of bile duct stones","volume":"66","author":"Kim","year":"2007","journal-title":"Gastrointest. Endosc."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Liang, C.M., Chiu, Y.C., Lu, L.S., Wu, C.K., Sou, F.M., Huang, P.Y., Ma, T.L., Kuo, C.H., Chuah, S.K., and Kuo, C.M. (2020, June 22). Optimal Timing of Single-Stage Retrograde Endoscopic Common Bile Duct Stone Removal in Mild and Moderate Acute Cholangitis: A Prospective Trial. Available online: https:\/\/www.researchsquare.com\/article\/rs-26612\/v1.","DOI":"10.21203\/rs.3.rs-26612\/v1"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/12\/2000\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:30:32Z","timestamp":1760146232000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/12\/2000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,30]]},"references-count":39,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["life12122000"],"URL":"https:\/\/doi.org\/10.3390\/life12122000","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,30]]}}}