Usefullness of the rendezvous technique of endoscopic stenting for biliary stricture

Aim: The rendezvous procedure combines the endoscopic technique with percutaneous- transhepatic- cholangiography to facilitate cannulation of the bile duct in cases where previous endoscopic attempts have failed. The combined technique increases the success rate of biliary tract cannulation and thus facilitates the diagnosis and treatment of biliary tract disorders.A few cases were reported that support of usefullness of the rendezvous technique in benign and malignant bile duct stenosis and stricture.

Patients and methods: The last two years the selective common bile duct cannulation cannot be performed at ERCP trying various endoscopic techniques in 6 patients/2 female, 4 male/. Mean age of pts was 52 years/32–92/. We evaluated the usefullness and safety of the rendezvous technique for the management of biliary stricture. The majority of pts/4/have unresectable hilar cholangiocarcinoma and 2 pts have postoperative CBD stricture. The radiologist had one PTD catheter or guide-wire passing over the stricture site in all pts. The guide-wire outside the papilla of Vater within the duodenal lumen was identified using the duodenoscope, and after sphincterotomy one plastic stent/4 pts/, or self-expandable metal stent/1 pt/, or naso-biliary drain/1 pt/were placed over the guide-wire. Complications of the rendezvous procedure included mild acute pancreatitis and one acute cholangitis, treated conservatively. Follow -up: two pts have benign biliary stricture are well, but the other pts died within 3 months after the procedure related to the underlying disease.

Conclusions: Endoscopic and percutaneous treatment/rendezvous technique/a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Percutaneuos biliary intervention has an important role in the management of benign and malignant biliary strictures is not only a short-term treatment, but also an adequate long-term therapeutic alternative to surgery, with tolerable complication rates.