Bile Duct Cannulation Guided by a Percutaneous Transhepatic Biliary Drainage (PTBD) Tube: Modified Rendezvous Procedure / 대한소화기내시경학회지

ABSTRACT

BACKGROUND/AIMS: To describe a simple and useful modification of the rendezvous technique using a PTBD tube as guidance. METHODS: From January 2005 to August 2006, a total of 436 ERCPs were performed. A diagnosis of choledocholithiasis was made in 235 cases. Deep cannulation of the bile duct using standard techniques was unsuccessful in 27 patients (11.5%). A precut papillotomy led to successful cannulation in 16 out of these 27 patients (59.3%). The remaining 11 patients (40.7%) underwent PTBD with the tube tip placed in the second portion of the duodenum. Bile duct cannulation was attempted with the guidance of a PTBD tube in 9 cases. In the other 2 cases, the transduodenal approach was impossible due to a previous Billroth II operation. RESULTS: Bile duct cannulation guided by a PTBD tube, which is also known as a modified rendezvous procedure, was successful in 9 out of 11 patients (81.8%). Deep cannulation of the bile duct was achieved in 100% of patients, who could be treated by endoscopy. There were 7 cases of transient hyperamylasemia (77.8%) but no procedure-related major complications or mortality. CONCLUSIONS: Bile duct cannulation guided by a PTBD tube in patients with choledocholithiasis can be recommended when ERCP is unsuccessful using the standard technique.