ENDOSCOPIC ULTRASOUND-GUIDED RENDEZVOUS TECHNIQUE FOR DIFFICULT CANNULATION INTO THE BILE DUCT

DOI 1 Citations
  • KAWAKUBO Kazumichi
    Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine.
  • KAWAKAMI Hiroshi
    Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine.
  • ISAYAMA Hiroyuki
    Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo.
  • SAKAMOTO Naoya
    Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine.

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  • カニュレーション困難例に対するEUS-guided rendezvous technique

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The endoscopic ultrasound (EUS)-guided rendezvous technique was reported to be a useful salvage method for patients with failed cannulation. In such patients, after bile duct puncture under EUS guidance, cholangiography was obtained. Then the guidewire was inserted through the needle into the bile duct and further antegradely advanced through the papilla into the duodenum. The echoendoscope was removed leaving the guidewire in place, followed by duodenoscope insertion. Finally, the bile duct was cannulated alongside of the guidewire or over the guidewire. The EUS-guided rendezvous technique is a complicated procedure and not yet standardized due to the absence of dedicated devices. However, the EUS-guided rendezvous technique allows reliable bile duct cannulation because of bile duct access under ultrasonographic guidance compared to conventional retrograde bile duct cannulation using the ERCP technique. However, the possibility of serious complications, such as bile leak or peritonitis, should be of concern due to bile duct access through the peritoneum or retroperitoneum. To gain familiarity with various approach routes in the EUS-guided rendezvous technique is essential for a successful procedure.

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