A novel “hitch-and-ride” deep biliary cannulation method during rendezvous endoscopic ultrasound-guided ERCP technique

Abstract

Background and study aim Endoscopic ultrasound-guided rendezvous (EUS-RV) is increasingly reported as a treatment option after failed endoscopic retrograde cholangiopancreatography. We developed a novel “hitch-and-ride” catheter for biliary cannulation to reduce the risk of guidewire loss during EUS-RV.

Patients and methods We retrospectively evaluated safety and technical success of EUS-RV between June 2011 and May 2016. Biliary cannulation during EUS-RV using three methods – over-the-wire, along-the-wire, and hitch-and-ride – were compared.

Results A total of 30 EUS-RVs were attempted and the technical success rate was 93.3 %, with two failures (one bile duct puncture and one guidewire insertion). After 28 cases of successful guidewire passage, cannulation was attempted by the over-the-wire (n = 13), along-the-wire (n = 4) or hitch-and-ride (n = 11) method. Only the hitch-and-ride method achieved biliary cannulation without guidewire loss or conversion to the other methods. Time to cannulation was shorter with the hitch-and-ride method (4 minutes) than with over-the-wire and along-the-wire methods (9 and 13 minutes, respectively). The adverse event rate of EUS-RV was 23.3 %.

Conclusion A novel hitch-and-ride catheter was feasible for biliary cannulation after EUS-RV.

• References

• 1 Bourke MJ, Costamagna G, Freeman ML. Biliary cannulation during endoscopic retrograde cholangiopancreatography: core technique and recent innovations. Endoscopy 2009; 41: 612-617
• 2 Yasuda I, Isayama H, Bhatia V. Current situation of endoscopic biliary cannulation and salvage techniques for difficult cases: Current strategies in Japan. Dig Endosc 2016; 28 (Suppl. 01) 62-69
• 3 Peng C, Nietert PJ, Cotton PB. et al. Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network. BMC Gastroenterol 2013; 13: 147
• 4 Mallery S, Matlock J, Freeman ML. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: report of 6 cases. Gastrointest Endosc 2004; 59: 100-107
• 5 Kahaleh M, Hernandez AJ, Tokar J. et al. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc 2006; 64: 52-59
• 6 Iwashita T, Lee JG, Shinoura S. et al. Endoscopic ultrasound-guided rendezvous for biliary access after failed cannulation. Endoscopy 2012; 44: 60-65
• 7 Shah JN, Marson F, Weilert F. et al. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc 2012; 75: 56-64
• 8 Dhir V, Bhandari S, Bapat M. et al. Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction. United European Gastroenterol J 2013; 1: 103-108
• 9 Kawakubo K, Isayama H, Sasahira N. et al. Clinical utility of an endoscopic ultrasound-guided rendezvous technique via various approach routes. Surg Endosc 2013; 27: 3437-3443
• 10 Iwashita T, Yasuda I, Mukai T. et al. EUS-guided rendezvous for difficult biliary cannulation using a standardized algorithm: a multicenter prospective pilot study (with videos). Gastrointest Endosc 2016; 83: 394-400
• 11 Tsuchiya T, Itoi T, Sofuni A. et al. Endoscopic ultrasonography-guided rendezvous technique. Dig Endosc 2016; 28 (Suppl. 01) 96-101
• 12 Nakai Y, Isayama H, Sasahira N. et al. Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP. Gastrointest Endosc 2015; 81: 119-126
• 13 Isayama H, Nakai Y, Kawakubo K. et al. The endoscopic ultrasonography-guided rendezvous technique for biliary cannulation: a technical review. J Hepatobiliary Pancreat Sci 2013; 20: 413-420
• 14 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 15 Holt BA, Hawes R, Hasan M. et al. Biliary drainage: role of EUS guidance. Gastrointest Endosc 2016; 83: 160-165