Usefulness of the Rendezvous Technique for Biliary Stricture after Adult Right-Lobe Living-Donor Liver Transplantation with Duct-To-Duct Anastomosis

Abstract

Background/Aims: Replacement of a percutaneous transhepatic biliary drainage (PTBD) catheter with inside stents using endoscopic retrograde cholangiography is difficult in patients with angulated or twisted biliary anastomotic stricture after living donor liver transplantation (LDLT). We evaluated the usefulness and safety of the rendezvous technique for the management of biliary stricture after LDLT. Methods: Twenty patients with PTBD because of biliary stricture after LDLT with duct-to-duct anastomosis underwent the placement of inside stents using the rendezvous technique. Results: Inside stents were successfully placed in the 20 patients using the rendezvous technique. The median procedure time was 29.6 (range, 7.5-71.8) minutes. The number of inside stents placed was one in 12 patients and two in eight patients. One mild acute pancreatitis and one acute cholangitis occurred, which improved within a few days. Inside stent related sludge or stone was identified in 12 patients during follow-up. Thirteen patients achieved stent-free status for a median of 281 (range, 70-1,351) days after removal of the inside stents. Conclusions:The rendezvous technique is a useful and safe method for the replacement of PTBD catheter with inside stent in patients with biliary stricture after LDLT with duct-to-duct anastomosis. The rendezvous technique could be recommended to patients with angulated or twisted strictures. (Gut Liver 2010; 4:68-75)

Endoscopic management of biliary strictures after living donor liver transplantation

“…After the guide wire has traversed the stricture via the PTBD route, endoscopic stent placement is relatively easy (Fig. 3) [78][79][80]. In cases with a completely obstructed BAS, in which identification of the anastomosis is difficult, we perform simultaneous cholangiogram via both an NBC and a PTBD tube to ensure the correct direction toward the anastomosis while attempting to pass a guide wire through the anastomosis via the PTBD route (Fig.…”

Comparative study of rendezvous techniques in post-liver transplant biliary stricture

“…However, stenting using ERCP in patients with angulated or twisted biliary strictures is difficult and sometimes fails. Our previous study showed that the rendezvous technique is a useful alternative method for successful placement of inside stents in these patients [13] . A few cases of biliary complication after liver transplantation have supported the usefulness of the rendezvous technique for biliary strictures and stones or biliary leakage from bile duct anastomosis [23][24][25] .…”

“…This combined technique increases the success rate of biliary tract cannulation and facilitates the diagnosis and treatment of biliary tract disorders [10][11][12] . We previously reported that the rendezvous technique allows for successful placement of inside stents in angulated or twisted biliary strictures after LDLT [13] . In the classic rendezvous technique, a guidewire is used for an endoscopic approach to the bile duct.…”

Percutaneous biliary intervention: tips and tricks

“…55,56 This technique has been shown to have good results in patients with angulated or twisted biliary strictures for replacement of PTBD catheters with inside stents in biliary strictures after living donor liver transplantation. 57 The classical 'rendezvous' technique used percutaneously inserted guidewire for endoscopic approach to the bile tree while subsequently, multiple modifications of the technique have been suggested including Kumpe catheter instead of guidewire with promising results. 58 Surgery remains the last resort to salvage the graft when multiple endoscopic and percutaneous attempts fail.…”