Rendezvous Technique for Bile Duct Drainage

Abstract

Purpose: Endoscopic bile duct drainage is the first choice of treatment for obstructive biliary tract disease. Selective bile duct cannulation is routinely performed via the major papilla during endoscopic procedures. However, endoscopists occasionally encounter cases where selective bile duct cannulation is difficult. In our hospital, we actively perform the rendezvous technique, which is a combination of percutaneous transhepatic and endoscopic treatments, to facilitate bile duct cannulation when presented with difficult cases. In the present study, we investigated the efficacy and safety of performing endoscopic procedures using the rendezvous technique following percutaneous transhepatic gallbladder biliary drainage (PTGBD). Methods: Percutaneous transhepatic biliary drains, or PTGBDs, were performed by advancing the guide wire into the duodenum via that route. We withdrew the guide wire through the scope and then performed the endoscopic procedure using the rendezvous technique. From January 2006 to October 2012, we performed 933 endoscopic retrograde cholangiopancreatographies (ERCPs) to treat obstructive jaundice. We used the rendezvous technique in 20 cases where cannulation was difficult. Results: We encountered 16 cases with malignant bile duct stenosis, two with parapapillary diverticula and two with postoperative stomachs, and achieved a 100% cannulation success rate. Pancreatitis after ERCP, bleeding, perforation or any other incidental complications were not observed. Conclusion: There is no risk of complications such as pancreatitis, because the rendezvous technique does not require a pancreatography. Through this approach, the procedure can be safely and easily performed in a short period of time, and it provides a secure endoscopic route. However, familiarity with both interventional treatments and endoscopic techniques is essential.