EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: report of 6 cases

Risks of transesophageal endoscopic ultrasonography-guided biliary drainage

“…EUS-BD includes EUS-guided choledochoduodenostomy, EUS-guided hepaticogastrostomy (EUS-HGS), EUS-guided hepaticoenterostomy (EUS-HES), and EUS-RV among others. Since the initial report in 2004, 5 several studies have supported the use of EUS-RV as an effective salvage technique to achieve biliary cannulation after failed ERCP. The EUS-RV technique comprises three methods based on the approach route: transgastric, transduodenal in a short endoscopic position, and transduodenal in a long endoscopic position.…”

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“…In 2001, EUS-guided biliary drainage was performed in two steps to achieve choledochoduodenostomy [260] and as a one-step technique to place plastic stents into the common bile duct or the dilated left intrahepatic duct (choledochoduodenostomy and hepaticojejuno/gastrostomy) [261]. Moreover, EUS-guided biliary rendezvous drainage in malignant obstructive jaundice after failed ERCP has been described [262]. EUS-guided cholangiography has also been described in benign diseases with unsuccessful ERCP (e. g. failed cannulation, duodenal diverticulum, choledochal cyst, chronic pancreatitis, postsurgical stricture) [263 -267].…”

“…Intra-ductal guidewire manipulation was the most restraining aspect, accounting for technical failure in 68 cases [289]. First reported in 2004 [262], other studies have described the rendezvous technique as effective in obtaining biliary cannulation [272, 289 -291], with a cumulative success rate (9 studies, n = 267) of 81 %, with a higher success rate for the extrahepatic over the intrahepatic route (87 %, n = 160 vs. 65 %, n = 62) [272]. The procedure and hospitalization time are significantly shorter for the extrahepatic compared to the intrahepatic approach, and the extrahepatic approach is associated with fewer adverse events, despite similar technical and clinical success rates [292].…”

Echoguided Hepatico-Gastrostomy: A Case Report

“…In two cases, Mallery et al 15 performed EH by cannulation adjacent to a EUS-placed wire, with a minor complication of wire passage outside the bile duct lumen. Puspok et al 16 reported successful (lower than 100%) EH with no immediate complications.…”