Modified rendezvous intrahepatic bile duct cannulation technique to pass a PTBD catheter in ERCP

The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access for subsequent rendezvous techniques.Traditionally,rendezvous procedures such as the PTBDassisted over-the-wire cannulation method,or the parallel cannulation technique,may be available when a bile duct cannot be selectively cannulated.When selective intrahepatic bile duct(IHD) cannulation fails,this modified rendezvous technique may be a feasible alternative.We report the case of a modified rendezvous technique,in which the guidewire was retrogradely passed into the IHD through the C2 catheter after end-to-end contact between the tips of the sphincterotome and the C2 catheter at the ampulla's orifice,in a 39-year-old man who had been diagnosed with gallbladder carcinoma with a metastatic right IHD obstruction.Clinically this procedure may be a feasible and timesaving technique.

Combined endoscopy/laparoscopy/percutaneous transhepatic biliary drainage, hybrid techniques in gastrointestinal and biliary diseases

In recent years,a wide range of gastrointestinal endoscopy techniques have been developed,such as endoscopic submucosal dissection(ESD)and endoscopic retrograde cholangiopancreatography(ERCP).Although ESD and ERCP have an important role in gastrointestinal and biliary diseases,each technique has its limitations.Hybrid techniques that combine endoscopic and surgical procedures have emerged that have the advantages of different procedures and negate their limitations at the same time.Laparoscopic endoscopic cooperative surgery and modified laparoscopic endoscopic cooperative surgery combine ESD and laparoscopic techniques to resect submucosal tumors with minimum resection area.Air leak test by intraoperative endoscopy can effectively identify a mechanically insufficient anastomosis and decrease the complication rate.The rendezvous technique that combines percutaneous transhepatic biliary drainage and endoscopy can be performed as a rescue approach for the treatment of biliary obstruction,stenosis and bile duct injuries.For patients with simultaneous presence of stones in the gallbladder and the common bile duct,the laparoendoscopic rendezvous technique can perform ERCP and laparoscopic cholecystectomy at the same time and reduces the risk of pancreatic injury caused by ERCP.Biliobiliary and bilioenteric anastomosis using magnetic compression anastomosis is another choice for biliary obstruction.The most common used approach to deliver the magnets is by percutaneous-peroral tract.Laparoscopicassisted ERCP is a safe and highly effective therapy for patients who develop biliary diseases after Roux-en-Y gastric bypass surgery.

Management of cholelithiasis with choledocholithiasis:Endoscopic and surgical approaches

Gallstone disease and complications from gallstones are a common clinical problem.The clinical presentation ranges between being asymptomatic and recurrent attacks of biliary pain requiring elective or emergency treatment.Bile duct stones are a frequent condition associated with cholelithiasis.Amidst the total cholecystectomies performed every year for cholelithiasis,the presence of bile duct stones is 5%-15%;another small percentage of these will develop common bile duct stones after intervention.To avoid serious complications that can occur in choledocholithiasis,these stones should be removed.Unfortunately,there is no consensus on the ideal management strategy to perform such.For a long time,a direct open surgical approach to the bile duct was the only unique approach.With the advent of advanced endoscopic,radiologic,and minimally invasive surgical techniques,however,therapeutic choices have increased in number,and the management of this pathological situation has become multidisciplinary.To date,there is agreement on preoperative management and the need to treat cholelithiasis with choledocholithiasis,but a debate still exists on how to cure the two diseases at the same time.In the era of laparoscopy and miniinvasiveness,we can say that therapeutic approaches can be performed in two sessions or in one session.Comparison of these two approaches showed equivalent success rates,postoperative morbidity,stone clearance,mortality,conversion to other procedures,total surgery time,and failure rate,but the onesession treatment is characterized by a shorter hospital stay,and more cost benefits.The aim of this review article is to provide the reader with a general summary of gallbladder stone disease in association with the presence of common bile duct stones by discussing their epidemiology,clinical and diagnostic aspects,and possible treatments and their advantages and limitations.

Endoscopic ultrasound-guided biliary drainage-current status and future perspectives

Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities.