Usefulness of the “Rendezvous” Technique in Living Related Right Liver Donors with Postoperative Biliary Leakage from Bile Duct Anastomosis

Despite experienced hands and availability of various well-designed catheters and wires, selective bile duct cannulation may still fail in 10–20% of cases during endoscopic retrograde cholangiopancreatography (ERCP). In case standard ERCP cannulation technique fails, salvage options include advanced ERCP cannulation techniques such as double-guidewire technique (DGW) with or without pancreatic stenting and precut papillotomy, percutaneous biliary drainage (PBD), and endoscopic ultrasound-guided Rendezvous (EUS-RV) ERCP. If the pancreatic duct is inadvertently entered during cannulation attempts, DGW technique is a reasonable next step, which can be followed by pancreatic stenting to reduce risks of post-ERCP pancreatitis (PEP). Studies suggest that early precut papillotomy is not associated with a higher risk of PEP, while needle-knife fistulotomy is the preferred method. For patients with critical clinical condition who may not be fit for endoscopy, surgically altered anatomy in which endoscopic biliary drainage is not feasible, and non-communicating multisegmental biliary obstruction, PBD has a unique role to provide successful biliary drainage efficiently in this particular population. As endoscopic ultrasound (EUS)-guided biliary drainage techniques advance, EUS-RV ERCP has been increasingly employed to guide bile duct access and cannulation with satisfactory clinical outcomes and is especially valuable for benign pathology at centres where expertise is available. Endoscopists should become familiar with each technique’s advantages and limitations before deciding the most appropriate treatment that is tailored to patient’s anatomy and clinical needs.

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Antegrade X-ray surgical interventions in patients with choledocholithiasis in case of failed endoscopic procedures

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2019248-59 ◽

2019 ◽

Vol 24 (2) ◽

pp. 48-59

Author(s):

O. I. Okhotnikov ◽

M. V. Yakovleva ◽

S. N. Grigoriev ◽

V. I. Pakhomov ◽

N. I. Shevchenko ◽

...

Keyword(s):

Surgical Treatment ◽

Bile Duct ◽

Common Bile Duct ◽

Postoperative Mortality ◽

Endoscopic Papillotomy ◽

X Ray ◽

Endoscopic Procedures ◽

Rendezvous Technique ◽

Antegrade Approach ◽

The Common

Objective. To analyze safety and efficacy of X-ray surgical treatment of choledocholithiasis in case of failed endoscopic procedures. Material and methods. A retrospective analysis included 195 patients with choledocholithiasis who underwent X-ray surgical treatment. Primary X-ray surgical intervention was antegrade cholangiostomy. Data of antegrade cholangiography were used to determine type of endobiliary intervention. Antegrade mechanical and pneumatic choledocholithotripsy and lithoextraction, balloon dislocation of stones of the common bile duct into duodenum or jejunum, lithoextraction using rendezvous technique after endoscopic papillotomy through transpapillary drainage tube or a wire were applied. Results. Puncture and drainage of non-dilated bile ducts were successfully performed in 30 (15.4%) patients. There were 212 procedires of cholangiostomy in 195 patients including redo interventions. Complications after cholangiostomy were absent in 92.9% of cases. Minor complications occurred in 7.1% of cases. Antegrade mechanical and pneumatic choledocholithotripsy and lithoextraction was performed in 118 (98.3%) patients. Balloon dislocation of stones of the common bile duct into duodenum was applied in 52 (81.3%) patients. Lithoextraction using rendezvous technique after previous endoscopic papillosphincterotomy was performed in 12 (60%) patients. Six patients underwent transpapillary external-internal drainage of common bile duct. Five patients had stricture of biliodigestive anastomosis complicated by cholelithiasis. Lithotripsy and lithoextraction through antegrade approach or dislocation of stones into jejunum after previous balloon dilatation were performed in these patients. Postoperative mortality was 1.5%. Minimally invasive techniques were absolutely effective for choledocholithiasis in 187 (98.9%) patients. Conclusion. Antegrade X-ray surgical management is effective and safe in patients with choledocholithiasis and unsuccessful previous endoscopic procedures. Integral efficiency of antegrade management of cholelithiasis was 88.8%.

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