Percutaneous-transhepatic-endoscopic rendezvous procedures are effective and safe in patients with refractory bile duct obstruction

Abstract

Background: Percutaneous-transhepatic-endoscopic rendezvous procedures (PTE-RVs) are rescue approaches used to facilitate biliary drainage.

Objective: The objective of this article is to evaluate the safety and the technical success of PTE-RVs in comparison with those of percutaneous transhepatic cholangiographies (PTCs).

Methods: Percutaneous procedures performed over a 10-year period were retrospectively analyzed in a single-center cohort. Examinations were performed because of a previous or expected failure of standard endoscopic methods including endoscopic retrograde cholangiography (ERC) or balloon-assisted ERC to achieve biliary access.

Results: In total, 553 percutaneous procedures including 163 PTE-RVs and 390 PTCs were performed. Overall, 71.3% of the patients suffered from malignant disease with pancreas-carcinoma (32.8%) and cholangio-carcinoma (19.0%) as the most frequent, while 28.7% of the patients suffered from benign disease. Many patients had a postoperative change in bowel anatomy (50.8%).PTC had a higher technical success rate (89.7%); however, the technical success rate of PTE-RVs was still high (80.4%; p < 0.003). Overall complications occurred in 23.5% of all procedures. Significantly fewer complications occurred after performing PTE-RVs than after PTCs (16.6% vs 26.4%; p = 0.037).

Conclusion: Beside a high technical efficacy of PTE-RVs, significantly fewer complications occur following PTE-RVs than following PTCs; thus, PTE-RV should be preferred over PTC alone in selected patients.

Keywords: Cholangiography; endoscopic rendezvous procedures; percutaneous cholangiography; percutaneous-transhepatic-endoscopic rendezvous techniques; safety.

Figure 1.

Imaging of a performed percutaneous-transhepatic-endoscopic rendezvous procedure (PTE-RV). (a–c) Guidewire placement via the transhepatic route into the intestinal lumen was performed. The conventional endoscopic intubation of the afferent limb with a single-balloon enteroscope failed. (d–h) An endoscopic snare was used to catch the transhepatic guidewire; thus, the endoscope could be advanced into the afferent limb up to the biliodigestive anastomosis to complete the RV procedure.