Journal of Hepato-Biliary-Pancreatic Sciences

, Volume 20, Issue 4, pp 413–420

The endoscopic ultrasonography-guided rendezvous technique for biliary cannulation: a technical review

Authors

    • Department of Gastroenterology, Graduate School of MedicineUniversity of Tokyo
  • Yousuke Nakai
    • Department of Gastroenterology, Graduate School of MedicineUniversity of Tokyo
  • Kazumichi Kawakubo
    • Department of Gastroenterology and HepatologyHokkaido University Graduate School of Medicine
  • Hiroshi Kawakami
    • Department of Gastroenterology and HepatologyHokkaido University Graduate School of Medicine
  • Takao Itoi
    • Department of GastroenterologyTokyo Medical University
  • Natsuyo Yamamoto
    • Department of Gastroenterology, Graduate School of MedicineUniversity of Tokyo
  • Hirofumi Kogure
    • Department of Gastroenterology, Graduate School of MedicineUniversity of Tokyo
  • Kazuhiko Koike
    • Department of Gastroenterology, Graduate School of MedicineUniversity of Tokyo
Review article

DOI: 10.1007/s00534-012-0577-8

Cite this article as:
Isayama, H., Nakai, Y., Kawakubo, K. et al. J Hepatobiliary Pancreat Sci (2013) 20: 413. doi:10.1007/s00534-012-0577-8

Abstract

Steady progress is being made in endoscopic biliary intervention, especially endoscopic ultrasonography (EUS)-guided procedures. The EUS-guided rendezvous technique (EUS-RV) is a salvage method for failed selective biliary cannulation. The overall success rate of EUS-RV in 247 cases from seven published articles was 74 % and the incidence of complications was 11 %. The main cause of failed rendezvous cannulation was difficulty passing a biliary stricture or papilla due to poor guidewire (GW) manipulation. A recent large study found a 98.3 % success rate and superiority to precutting. This report suggested using a hydrophilic guidewire. Major complications were bleeding (0.8 %), bile leakage (1.2 %), peritonitis (0.4 %), pneumoperitoneum (0.2 %), and pancreatitis (1.6 %). The approach routes for EUS-RV were transgastric, transduodenal short position, and transduodenal long position. The appropriate route for each patient should be used. GW selection for EUS-RV is critical, and a hydrophilic GW might be the most useful. The catheter can be inserted through the papilla alongside or over the wire. Alongside cannulation is convenient, but difficult. The problem with the over-the-wire technique is withdrawal of the GW in the accessory channel. EUS-RV is effective and safe, but is not established. The efficacy should be confirmed in a prospective comparative trial, and the necessary specialist equipment should be developed.

Keywords

Endoscopic ultrasonography (EUS) Interventional EUS EUS-RV Biliary cannulation Rendezvous

Abbreviations

GW

Guide-wire

EUS

Endoscopic ultrasonography

EUS-RV

Endoscopic ultrasonography-guided rendezvous technique

PTBD

Percutaneous transhepatic biliary drainage

ERCP

Endoscopic retrograde cholangiopancreatography

TG

Trans-gastric

TD

Trans-duodenal

TDS

Trans-duodenal short position

TDL

Trans-duodenal long position

EUS-CDS

Endoscopic ultrasonography-guided choledochoduodenostomy

ALC

Alongside cannulation

OWC

Over-the-wire cannulation

Copyright information

© Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer Japan 2012