scholarly journals Troubleshooting Difficult Bile Duct Access: Advanced ERCP Cannulation Techniques, Percutaneous Biliary Drainage, or EUS-Guided Rendezvous Technique?

2021 ◽  
Vol 12 (4) ◽  
pp. 405-422
Author(s):  
Ting-Ting Chan ◽  
Marcus C. H. Chew ◽  
Raymond S. Y. Tang
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Percutaneous Biliary Drainage ◽  
Rendezvous Technique ◽  
Surgically Altered Anatomy ◽  
Appropriate Treatment ◽  
Benign Pathology ◽  
Cannulation Technique ◽  
Needle Knife

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.

Tu1621 Single Session EUS-Rendezvous ERCP Versus Percutaneous Biliary Drainage in Patients With Failed Common Bile Duct Access After ERCP

2015 ◽  
Vol 81 (5) ◽  
pp. AB533
Author(s):  
Anthony Y. Teoh ◽  
Takuji Iwashita ◽  
Tsuyoshi Mukai ◽  
Vinay K. Dhir ◽  
Amit P. Maydeo ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Drainage ◽  
Single Session ◽  
Percutaneous Biliary Drainage

scholarly journals A Proposed Algorithm for Endoscopic Ultrasound-Guided Rendezvous Technique in Failed Biliary Cannulation

2020 ◽  
Vol 9 (12) ◽  
pp. 3879
Author(s):  
Saburo Matsubara ◽  
Keito Nakagawa ◽  
Kentaro Suda ◽  
Takeshi Otsuka ◽  
Hiroyuki Isayama ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Extrahepatic Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Duodenal Bulb ◽  
Ultrasound Guided ◽  
Biliary Cannulation ◽  
Rendezvous Technique ◽  
Selection Of ◽  
Approach Route

Background: The selection of an approach route in endoscopic ultrasound-guided rendezvous (EUS-RV) for failed biliary cannulation is complicated. We proposed an algorithm for EUS-RV. Methods: We retrospectively evaluated consecutive EUS-RV cases between April 2017 and July 2020. Puncturing the distal extrahepatic bile duct (EHBD) from the duodenal second part (D2) (DEHBD/D2 route) was attempted first. If necessary, puncturing the proximal EHBD from the duodenal bulb (D1) (PEHBD/D1 route), puncturing the left intrahepatic bile duct (IHBD) from the stomach (LIHBD/S route), or puncturing the right IHBD from the D1 (RIHBD/D1 route) were attempted in this order. Results: A total of 16 patients were included. The DEHBD/D2 route was used in 10 (62.5%) patients. The PEHBD/D1 route was attempted in five (31.3%) patients, and the biliary puncture failed in one patient in whom the RIHBD/D1 route was used because of tumor invasion to the left hepatic lobe. The LIHBD/S route was applied in one (6.3%) patient. Successful biliary cannulation was achieved in all patients eventually. The time from the puncture to the guidewire placement in the DEHBD/D2 route (3.5 min) was shorter than that in other methods (14.0 min) (p = 0.014). Adverse events occurred in one (6.3%) patient with moderate pancreatitis. Conclusions: The proposed algorithm might be useful for the selection of an appropriate approach route in EUS-RV.

Plastic surgery for cutaneous seeding of bile duct cancer following percutaneous biliary drainage

1999 ◽  
Vol 22 (5-6) ◽  
pp. 273-275
Author(s):  
A. Shiba ◽  
M. Hatoko ◽  
T. Okazaki ◽  
M. Kuwahara ◽  
A. Tanaka ◽  
...  
Keyword(s):  
Bile Duct ◽  
Plastic Surgery ◽  
Biliary Drainage ◽  
Bile Duct Cancer ◽  
Percutaneous Biliary Drainage ◽  
Duct Cancer

scholarly journals Antegrade Therapy for Management of Choledocholithiasis through Endoscopic Ultrasound-Guided Hepaticogastrostomy in a Patient with Surgically Altered Gastrointestinal Anatomy

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Robert Dorrell ◽  
Katelyn Madigan ◽  
Swati Pawa ◽  
Rishi Pawa
Keyword(s):  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Partial Gastrectomy ◽  
Biliary Tree ◽  
Ultrasound Guided ◽  
Electrohydraulic Lithotripsy ◽  
Surgically Altered Anatomy ◽  
History Of ◽  
Intraductal Therapy ◽  
Transhepatic Biliary Drainage

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a technique used to access the biliary tree in patients with surgically altered anatomy. Additionally, development of EUS-HG fistula permits intraductal therapy, thereby preventing patients from requiring surgery or percutaneous transhepatic biliary drainage (PTBD), thus decreasing morbidity. This clinical vignette describes an 83-year-old man with a history of gangrenous cholecystitis requiring cholecystectomy, partial gastrectomy, and Roux-en-Y gastrojejunostomy who presented to an outside hospital with abdominal pain and fever and found to have cholangitis and choledocholithiasis. He underwent two endoscopic retrograde cholangiopancreatography (ERCP) procedures at an outside hospital which were unsuccessful due to an inaccessible major papilla in the setting of the patient’s surgically altered anatomy. On arrival to Wake Forest, the patient underwent EUS-HG with successful biliary drainage and resolution of cholangitis. He returned for ERCP three months later with balloon sphincteroplasty, cholangioscopy, and electrohydraulic lithotripsy (EHL) performed through the existing metal stent (hepaticogastrostomy), resulting in stone fragmentation and antegrade removal with balloon sweeps. Repeat cholangioscopy post-EHL and balloon sweeps showed complete duct clearance with no residual stones. The hepaticogastrostomy stent was subsequently removed, and the patient recovered without any complications.

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