Parallel cannulation technique at ERCP rendezvous

Abstract

Biliary access at ERCP rendezvous is usually achieved by withdrawing a wire passed antegrade via the accessory channel of the duodenoscope, which is then used for over-the-wire cannulation. The wire is time consuming to maneuver and may be damaged during withdrawal. Description of a simple technique for cannulation at rendezvous that overcomes these problems. Observational study. Gastroenterology department of a teaching district general hospital. Fourteen consecutive patients undergoing rendezvous after percutaneous transhepatic cholangiography (PTC). A transpapillary drain was placed at PTC in 13 patients. At rendezvous, cannulation alongside the drain was attempted with a sphincterotome cannula. After successful cannulation, the drain was progressively withdrawn, allowing retrograde therapeutic intervention. In all 13 patients, parallel cannulation was successful, allowing stone removal or biliary stent placement, with cannulation alongside a guidewire in the fourteenth patient. There were no complications except right hypochondrial pain after drain removal. Parallel cannulation is straightforward and effective, avoiding the need for guidewire manipulation.