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Endoscopic Ultrasound-Guided Rendezvous Technique for Failed Biliary Cannulation in Benign and Resectable Malignant Biliary Disorders

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Abstract

Background

Endoscopic ultrasound-guided rendezvous technique (EUS-RV) has emerged as an effective salvage method for unsuccessful biliary cannulation. However, its application for benign and resectable malignant biliary disorders has not been fully evaluated.

Aims

To assess the efficacy and safety of EUS-RV for benign and resectable malignant biliary disorders.

Methods

This was a multicenter prospective study from 12 Japanese referral centers. Patients who underwent EUS-RV after failed biliary cannulation for biliary disorder were candidates for this study. Inclusion criteria were unsuccessful biliary cannulation for therapeutic endoscopic retrograde cholangiopancreatography with benign and potentially resectable malignant biliary obstruction. Exclusion criteria included unresectable malignant biliary obstruction, inaccessible papillae due to surgically altered upper gastrointestinal anatomy or duodenal stricture, and previous sphincterotomy and/or biliary stent placement. The primary outcome was the technical success rate of biliary cannulation; procedure time, adverse events, and clinical outcomes were secondary outcomes.

Results

Twenty patients were prospectively enrolled. The overall technical success rate and median procedure time were 85% and 33 min, respectively. Guidewire manipulation using a 4-Fr tapered tip catheter contributed to the success in advancing the guidewire into the duodenum. Adverse events were identified in 15% patients, including 2 with biliary peritonitis and 1 mild pancreatitis. EUS-RV did not affect surgical maneuvers or complications associated with surgery, or postoperative course.

Conclusions

EUS-RV may be a safe and feasible salvage method for unsuccessful biliary cannulation for benign or resectable malignant biliary disorders. Use of a 4-Fr tapered tip catheter may improve the overall EUS-RV success rate.

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Acknowledgments

The present study was supported by grants from the Japan Society for the Promotion of Science.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan

    Hideyuki Shiomi, Atsuhiro Masuda & Mamoru Takenaka

  2. Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, 589-8511, Japan

    Kentaro Yamao, Kosuke Minaga, Hajime Imai & Mamoru Takenaka

  3. Department of Gastroenterology, Bellland General Hospital, Sakai, Osaka, 599-8247, Japan

    Noriyuki Hoki

  4. Department of Internal Medicine, Saku Central Hospital Advanced Care Center, Nagano, 384-0301, Japan

    Takeshi Hisa

  5. Second Department of Internal Medicine, Osaka Medical College, Takatsuki, 569-8686, Japan

    Takeshi Ogura

  6. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, 640-8558, Japan

    Kosuke Minaga

  7. Department of Gastroenterology, Tottori University Hospital, Yonago, 683-8504, Japan

    Kazuya Matsumoto

  8. Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan

    Hironari Kato

  9. Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa, 761-0793, Japan

    Hideki Kamada

  10. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tottori Red Cross Hospital, Tottori, 680-8517, Japan

    Daisuke Goto

  11. Department of Gastroenterology, Shinbeppu Hospital, 3898 Tsurumi, Beppu-shi, Oita, 874-0833, Japan

    Chishio Noguchi

  12. Department of Gastroenterology, Oita Sanai Medical Center, Oita, 870-1151, Japan

    Hidefumi Nishikiori

  13. Clinical Research Center, Kinki University Hospital, Osaka-sayama, 589-8511, Japan

    Yasutaka Chiba

  14. Center for Clinical Research and Advanced Medicine Establishment, Shiga University of Medical Science, Otsu, 520-2192, Japan

    Hiromu Kutsumi

  15. Second Department of Internal Medicine, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 641-8509, Japan

    Masayuki Kitano

Authors
  1. Hideyuki Shiomi
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  2. Kentaro Yamao
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  3. Noriyuki Hoki
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  4. Takeshi Hisa
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  5. Takeshi Ogura
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  6. Kosuke Minaga
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  7. Atsuhiro Masuda
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  8. Kazuya Matsumoto
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  9. Hironari Kato
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  10. Hideki Kamada
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  11. Daisuke Goto
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  12. Hajime Imai
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  13. Mamoru Takenaka
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  14. Chishio Noguchi
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  15. Hidefumi Nishikiori
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  16. Yasutaka Chiba
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  17. Hiromu Kutsumi
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  18. Masayuki Kitano
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Contributions

HS contributed to conception and design, collection, data analysis and interpretation, manuscript drafting, manuscript revision, approval of the final version of the manuscript; KY, NH, TH, TO, KM, and AM helped in data collection, analysis, interpretation, manuscript revision, and approval of final version of the manuscript; KM, HK, HK, DG, HI, MT, CN, and HN helped in data collection and approval of the final version of the manuscript; YC, HK, and MK contributed to conception and design, manuscript revision, and approval of the final version of the manuscript.

Corresponding author

Correspondence to Masayuki Kitano.

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The authors have no conflict of interest to declare.

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Shiomi, H., Yamao, K., Hoki, N. et al. Endoscopic Ultrasound-Guided Rendezvous Technique for Failed Biliary Cannulation in Benign and Resectable Malignant Biliary Disorders. Dig Dis Sci 63, 787–796 (2018). https://doi.org/10.1007/s10620-018-4908-8

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  • DOI: https://doi.org/10.1007/s10620-018-4908-8

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