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Articles

Title: The rendezvous procedures in the treatment of bile duct stones in patients treated unsuccessfully with ERCP

Author:
Przemysław Besser
Type:
Review articles
Language:
EN
Journal:
Polish Gastroenterology
Year:
2003
Volume:
10
Number:
5
Start page:
421
Final page:
424
ISSN:
1232-9886
Keywords:
rendezvous procedure, ERCP, bile duct stones
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Introduction: The preferred treatment for bile duct stones is endoscopic sphincterotomy followed by stone extraction. When this fails, the rendezvous technique (a combination of endoscopy with percutaneuos trans-hepatic cholangiography) can facilitate cannulation of bile duct and be an alternative to surgery. Aim of the study: The purpose of this study was to evaluate the success and complication rate of this treatment. Material and methods: 11 pts (3 men, 8 women, mean age 61 years) with choledocholithiasis underwent ren-dezvous procedures after 2 unsuccessful attempts of endoscopic cannulation. Puncture of the intrahepa-tic bile duct system was performed under US and direct radiologic vision and percutane guidewire was in-troduced percutaneously via the bile ducts and the papilla of Vater into duodenum. This facilitates endoscopic localization and cannulation of the papilla as well as sphincterotomy and thus removal of the stones. Stones 1cm or larger in size were fragmented with Dormia baskets (mechanical lithotripsy). Results: 10 pts (91 %) who underwent rendezvous procedure were free of stones. In 7 pts all stones during this session were removed. In the remaining 3 pts, in the first phase 10F endoprothesis in biliary system was placed and after 7 days it was removed with stones. In 1 patient clearance of bile stones into the duodenum failed because of stenosis in common bile duct. This patient underwent surgery. There was no complication directly attributable to this technique. Conclusion: Rendezvous procedure is a safe and effective treatment for bile duct stones when previous endoscopic cannulation has been impossible.