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. 2017 Dec 1;56(23):3135-3143.
doi: 10.2169/internalmedicine.8677-16. Epub 2017 Sep 25.

Endoscopic Ultrasound-guided Rendezvous Technique after Failed Endoscopic Retrograde Cholangiopancreatography: Which Approach Route Is the Best?

Nozomi Okuno  1 , Kazuo Hara  1 , Nobumasa Mizuno  1 , Susumu Hijioka  1 , Masahiro Tajika  2 , Tsutomu Tanaka  2 , Makoto Ishihara  2 , Yutaka Hirayama  2 , Sachiyo Onishi  2 , Yasumasa Niwa  1   2 , Kenji Yamao  1
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Endoscopic Ultrasound-guided Rendezvous Technique after Failed Endoscopic Retrograde Cholangiopancreatography: Which Approach Route Is the Best?

Nozomi Okuno et al. Intern Med. .

Abstract

Objective The endoscopic ultrasound-guided rendezvous technique (EUS-RV) is a salvage method for failed selective biliary cannulation. Three puncture routes have been reported, with many comparisons between the intra-hepatic and extra-hepatic biliary ducts. We used the trans-esophagus (TE) and trans-jejunum (TJ) routes. In the present study, the utility of EUS-RV for biliary access was evaluated, focusing on the approach routes. Methods and Patients In 39 patients, 42 puncture routes were evaluated in detail. EUS-RV was performed between January 2010 and December 2014. The patients were prospectively enrolled, and their clinical data were retrospectively collected. Results The patients' median age was 71 (range 29-84) years. The indications for endoscopic retrograde cholangiopancreatography (ERCP) were malignant biliary obstruction in 24 patients and benign biliary disease in 15. The technical success rate was 78.6% (33/42) and was similar among approach routes (p=0.377). The overall complication rate was 16.7% (7/42) and was similar among approach routes (p=0.489). However, mediastinal emphysema occurred in 2 TE route EUS-RV patients. No EUS-RV-related deaths occurred. Conclusion EUS-RV proved reliable after failed ERCP. The selection of the appropriate route based on the patient's condition is crucial.

Keywords: ERCP; EUS; EUS-RV.

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Figures

Figure 1.
Figure 1.
EUS-Rendezvous technique. A, B: Trans-gastric route. The left intra-hepatic bile duct (B3) was punctured using the 19-G needle, and cholangiography was obtained (A). The guide wire was passed through the biliary stricture and papilla (B). The trans-esophagus and trans-jejunum routes are similar. C, D: Trans-duodenal long position. The extra-hepatic bile duct was punctured from the duodenum, and cholangiography was obtained (C). The guide wire passed through the papilla (D). E, F: Trans-duodenal short position. The extra-hepatic bile duct was punctured from the second portion of the duodenum, and the guide wire was passed through the papilla (E). The scope was exchanged for a duodenoscope while keeping the guide wire in place (F).
Figure 2.
Figure 2.
Loop cutter (Olympus Medical Systems).
Figure 3.
Figure 3.
Computed tomography revealed mediastinal emphysema and pneumothorax.
Figure 4.
Figure 4.
Proposed treatment procedure using endoscopic ultrasound-guided biliary drainage after failed ERCP.
See this image and copyright information in PMC

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