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Surgical Endoscopy

, Volume 27, Issue 9, pp 3437–3443 | Cite as

Clinical utility of an endoscopic ultrasound-guided rendezvous technique via various approach routes

  • Kazumichi KawakuboEmail author
  • Hiroyuki Isayama
  • Naoki Sasahira
  • Yousuke Nakai
  • Hirofumi Kogure
  • Tsuyoshi Hamada
  • Koji Miyabayashi
  • Suguru Mizuno
  • Takashi Sasaki
  • Yukiko Ito
  • Natsuyo Yamamoto
  • Kenji Hirano
  • Minoru Tada
  • Kazuhiko Koike
Dynamic Manuscript

Abstract

Background

The endoscopic ultrasound-guided rendezvous techniques (EUS-rendezvous) provide reliable biliary access after failed endoscopic retrograde cholangiopancreatography (ERCP) cannulation. We evaluated the clinical utility of an EUS-rendezvous technique using various approach routes.

Methods

Patients undergoing EUS-rendezvous for biliary access after failed bile duct cannulation in ERCP were included. EUS-rendezvous was performed via three approach routes depending on the patient’s condition: transgastric, transduodenal in a short endoscopic position, or transduodenal in a long endoscopic position. The main outcomes were the technical success rates. Secondary outcomes were procedure time and complications.

Results

Fourteen patients (median age, 77 years) underwent EUS-rendezvous for biliary access resulting from failed biliary cannulation. The reasons for biliary drainage were malignant biliary obstruction in five patients and choledocholithiasis in nine. Transgastric, transduodenal in a short position, and transduodenal in a long position EUS-rendezvous was performed in five, five, and four patients, respectively. Bile duct puncture occurred in the left intrahepatic duct in four patients, right hepatic duct in one, middle common bile duct in four, and lower common bile duct in five. The technical success rate was 100 %. In four patients, the approach route was modified from transduodenal in a short position to transduodenal in a long position or transgastric route. The median procedure time was 81 min. One case each of biliary peritonitis and pancreatitis occurred and were managed conservatively.

Conclusions

EUS-rendezvous provided safe and reliable transpapillary bile duct access after failed ERCP cannulation. The selection of the appropriate approach routes, depending on patient condition, is critical.

Keywords

EUS-guided intervention EUS-guided rendezvous Biliary cannulation 

Notes

Acknowledgments

We are grateful to Dr. Naminatsu Takahara, Dr. Rie Uchino, Dr. Dai Mohri, and Dr. Keisuke Yamamoto (Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan) for their assistance.

Disclosures

K. Kawakubo, H. Isayama, N. Sasahira, Y. Nakai, H. Kogure, T. Hamada, K. Miyabayashi, S. Mizuno, T. Sasaki, Y. Ito, N. Yamamoto, K. Hirano, M. Tada, and K. Koike have no conflicts of interest or financial ties to disclose.

Supplementary material

Video 1

Transduodenal endoscopic ultrasound-guided rendezvous technique (EUS-rendezvous) in a short endoscopic position in a patient with choledocholithiasis. (WMV 14036 kb)

Video 2

Transduodenal endoscopic ultrasound-guided rendezvous technique (EUS-rendezvous) in a long endoscopic position in a patient with choledocholithiasis. (WMV 11841 kb)

Video 3

Transgastric endoscopic ultrasound-guided rendezvous technique (EUS-rendezvous) in a patient with distal malignant biliary obstruction. (WMV 13224 kb)

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kazumichi Kawakubo
    • 1
    Email author
  • Hiroyuki Isayama
    • 1
  • Naoki Sasahira
    • 1
  • Yousuke Nakai
    • 1
  • Hirofumi Kogure
    • 1
  • Tsuyoshi Hamada
    • 1
  • Koji Miyabayashi
    • 1
  • Suguru Mizuno
    • 1
  • Takashi Sasaki
    • 1
  • Yukiko Ito
    • 1
  • Natsuyo Yamamoto
    • 1
  • Kenji Hirano
    • 1
  • Minoru Tada
    • 1
  • Kazuhiko Koike
    • 1
  1. 1.Department of GastroenterologyGraduate School of Medicine, The University of TokyoTokyoJapan

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