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Percutaneous transgallbladder rendezvous for enteroscopic management of choledocholithiasis in patients with surgically altered anatomy.

Abstract：

INTRODUCTION:Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered upper gastrointestinal anatomy (SAA) is generally challenging despite the use of enteroscopy. After failed biliary cannulation, rendezvous technique (RV) can be an option to assist the biliary access. However, proper needle puncture of biliary ducts, which is critical in the RV procedure, can be difficult because of insufficient biliary dilation. By contrast, the gallbladder can be punctured as a possible access route for RV. AIM:To evaluate the feasibility and safety of percutaneous transgallbladder (PTGB)-RV in patients with SAA. PATIENTS AND METHODS:Six patients who underwent PTGB-RV were included. PTGB drainage was performed in cases without sufficient biliary duct dilation. A guidewire was inserted through the PTGB route with antegrade passage through the cystic duct, common bile duct and duodenal papilla. An enteroscope was inserted up to the papilla, at the guidewire exit site. The guidewire was pulled out through the accessory channel followed by biliary cannulation over the guidewire and endoscopic papillary balloon dilation (EPBD) for stone removal. RESULTS:Six patients with SAA (Roux-en-Y in 4 and Billroth-II in 2) underwent PTGB-RV for removal of bile duct stones. In all patients, a guidewire was successfully inserted into the duodenum followed by insertion of the enteroscope and biliary cannulation. EPBD was then performed, but subsequent stone removal failed in 1 patient. Stone removal was successful in 5 patients without complication, except 1 case of mild pancreatitis. CONCLUSION:PTGB-RV seems to be a feasible and relatively safe salvage technique in patients with SAA.

journal_name

Scand J Gastroenterol

journal_title

Scandinavian journal of gastroenterology

authors

Okuno M,Iwashita T,Yasuda I,Mabuchi M,Uemura S,Nakashima M,Doi S,Adachi S,Mukai T,Moriwaki H

doi

10.3109/00365521.2013.805812

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

974-8

issue

eissn

0036-5521

issn

1502-7708

journal_volume

pub_type

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Percutaneous transgallbladder rendezvous for enteroscopic management of choledocholithiasis in patients with surgically altered anatomy.