Review article

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

  • Hiroyuki IsayamaAffiliated withDepartment of Gastroenterology, Graduate School of Medicine, University of Tokyo Email author 
  • , Yousuke NakaiAffiliated withDepartment of Gastroenterology, Graduate School of Medicine, University of Tokyo
  • , Kazumichi KawakuboAffiliated withDepartment of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine
  • , Hiroshi KawakamiAffiliated withDepartment of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine
  • , Takao ItoiAffiliated withDepartment of Gastroenterology, Tokyo Medical University
  • , Natsuyo YamamotoAffiliated withDepartment of Gastroenterology, Graduate School of Medicine, University of Tokyo
  • , Hirofumi KogureAffiliated withDepartment of Gastroenterology, Graduate School of Medicine, University of Tokyo
  • , Kazuhiko KoikeAffiliated withDepartment of Gastroenterology, Graduate School of Medicine, University of Tokyo

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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