Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos)

Dhir,; Bhandari, Suryaprakash; Bapat, Mukta; Maydeo, Amit

doi:10.1016/j.gie.2011.07.075

Cited by 189 publications

(145 citation statements)

References 17 publications

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“…However, an individually higher risk of complications from any procedure may be indicated by failed primary biliary cannulation in cases selected for EUS-BD. A retrospective study found a higher complication rate for endoscopic precut papillotomy than for the EUS-guided rendezvous procedure after failed primary biliary cannulation [133]. Complication rates in EUS-guided drainage procedures have been shown to decrease with growing experience of centers and single endoscopists [134, 135].…”

Section: Endoscopic Therapymentioning

confidence: 99%

Endoscopic and Conservative Management of Chronic Pancreatitis and Its Complications

et al. 2019

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Section: Endoscopic Therapymentioning

confidence: 99%

Endoscopic and Conservative Management of Chronic Pancreatitis and Its Complications

et al. 2019

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“…EUS is being increasingly used as an alternative to percutaneous techniques for accessing the biliary tract for combined procedures [21]. The major advantage of EUS-guided biliary approach is that both guide wire passage and ERCP can be undertaken in the same session (Figure 8.4a-d).…”

Section: Eus-guided Approachmentioning

confidence: 99%

When standard cannulation approaches fail

Lakhtakia

Holt

2014

Ercp

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principles of biliary accessThe principle of selective biliary cannulation is akin to a skilled firefighter (endoscopist) who has to enter a building (bile duct) to evacuate trapped residents (obstructive pathology). Unlocking the latches at the entry gate (standard cannulation) should be the first attempt to enter the building without bothering the neighbor (pancreas). Trying to break in (traumatic cannulation attempts) or repeated knocking at the neighbor's door (pancreatic injections) can complicate the situation (post-ERCP pancreatitis (PEP)). If the neighbor's (pancreas) gate opens first, it is prudent to evacuate him (prophylactic pancreatic duct (PD) stent) to limit damage. Once successful entry is gained into the building (selective bile duct cannulation) the doors can be opened (sphincterotomy) to enable entry of fire extinguishers (accessories) to facilitate the exit of trapped residents (obstructed bile). If entry from the main gate to the building is not possible, a drill can be used Key points• Selective cannulation is almost always achievable by experts using standard methods in patients with normal anatomy and no major pathology in the region of the papilla.• When difficulties arise, deep biliary cannulation is best attempted using double guide wire and needle-knife techniques (best over a pancreatic stent).• Rendezvous approaches allow endoscopic retrograde cholangiopancreatography (ERCP) after a guide wire has been passed antegradely through the papilla via the transhepatic route, or with endoscopic ultrasound (EUS).• Patients with surgically altered biliary anatomy are increasingly common and pose the greatest challenges.• These advanced techniques carry significant risks.

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“…[4][5][6] These procedures are considered to have a lower risk of severe peritonitis compared with EUS-HGS and CDS. Therefore, a means of reducing complications and troubleshooting techniques for EUS-BD should be established.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage: Complications and their management

Isayama

Nakai

Yamamoto

et al. 2017

Int J Gastrointest Interv

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A B S T R A C T Endoscopic ultrasound-guided biliary drainage (EUS-BD), EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS) can effectively palliate obstructive jaundice, but have not been well established yet. The incidence of complications is about 30% in EUS-BD and higher for EUS-HGS. Several complications have been reported such as bleeding, perforation and peritonitis. Bleeding occurs due to puncture of portal vein, hepatic vein and artery, and we should use color Doppler. When a cautery dilator is used for fistula dilation, burn effects may cause delayed bleeding. Endoscopic hemostasis is only effective for anastomotic bleeding and embolization with interventional radiology technique is required for pseudo aneurysm. There are some types of perforation: failed stent placement after puncture or fistula dilation, double puncture during CDS procedure, and stent migration. Peritonitis with perforation requires surgery and can be fatal. Stent migration before mature fistula formation causes severe peritonitis because EUS-BD makes fistula between two unattached organs. Stents with flaps or long covered self-expandable metallic stents (cSEMSs) are effective to prevent migration. Recent development of lumen apposing stents may reduce early migration in EUS-CDS. Peritonitis without migration can be due to 1) leakage of bile juice or gastric/duodenal contents during EUS-BD or 2) leakage along the placed stent. We should make procedure time as short as possible, and cSEMSs reduce bile leak along the stent by occluding the dilated fistula. In summary, we should understand the mechanism of complications and the technique to prevent and manage complications. Development of dedicated devices to increase the success rate and reduce complications is required.

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Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos)

Cited by 189 publications

References 17 publications

Endoscopic and Conservative Management of Chronic Pancreatitis and Its Complications

Endoscopic and Conservative Management of Chronic Pancreatitis and Its Complications

When standard cannulation approaches fail

Endoscopic ultrasound-guided biliary drainage: Complications and their management

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