Abstract:Twenty‐eight high risk patients with acute cholangitis due to large common bile duct stones underwent endoscopic stenting for biliary drainage. Seventeen patients were subsequently readmitted for stone extraction after a mean interval of 4 months, 13 on an elective basis and 4 because of recurrent cholangitis. Six patients were noted to have spontaneous reduction in stone size and two had complete stone disintegration. Endoscopic stone extraction was successful in 15 patients. Two patients in whom the stone extraction failed had their stents changed. Two patients died of nonbiliary related causes. The remaining patients were asymptomatic during a follow up period of 4 to 19 months. Endoscopic stenting provides effective temporary drainage for acute cholangitis. Elective stone extraction can be performed when sepsis is controlled. In elderly high risk patients, stenting can be used as a definitive treatment for large common duct stones. (Dig Endosc 1994; 6 : 45