Endoscopic Ultrasound-Guided Rendezvous Technique for Failed Biliary Cannulation in Benign and Resectable Malignant Biliary Disorders

Hideyuki Shiomi; Kentaro Yamao; Noriyuki Hoki; Takeshi Hisa; Takeshi Ogura; Kosuke Minaga; Atsuhiro Masuda; Kazuya Matsumoto; Hironari Kato; Hideki Kamada; Daisuke Goto; Hajime Imai; Mamoru Takenaka; Chishio Noguchi; Hidefumi Nishikiori; Yasutaka Chiba; Hiromu Kutsumi; Masayuki Kitano

doi:10.1007/s10620-018-4908-8

Endoscopic Ultrasound-Guided Rendezvous Technique for Failed Biliary Cannulation in Benign and Resectable Malignant Biliary Disorders

Dig Dis Sci. 2018 Mar;63(3):787-796. doi: 10.1007/s10620-018-4908-8. Epub 2018 Jan 18.

Authors

Hideyuki Shiomi¹, Kentaro Yamao², Noriyuki Hoki³, Takeshi Hisa⁴, Takeshi Ogura⁵, Kosuke Minaga^{2

6}, Atsuhiro Masuda¹, Kazuya Matsumoto⁷, Hironari Kato⁸, Hideki Kamada⁹, Daisuke Goto¹⁰, Hajime Imai², Mamoru Takenaka^{1

2}, Chishio Noguchi¹¹, Hidefumi Nishikiori¹², Yasutaka Chiba¹³, Hiromu Kutsumi¹⁴, Masayuki Kitano¹⁵

Affiliations

¹ Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.
² Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, 589-8511, Japan.
³ Department of Gastroenterology, Bellland General Hospital, Sakai, Osaka, 599-8247, Japan.
⁴ Department of Internal Medicine, Saku Central Hospital Advanced Care Center, Nagano, 384-0301, Japan.
⁵ Second Department of Internal Medicine, Osaka Medical College, Takatsuki, 569-8686, Japan.
⁶ Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, 640-8558, Japan.
⁷ Department of Gastroenterology, Tottori University Hospital, Yonago, 683-8504, Japan.
⁸ Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan.
⁹ Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa, 761-0793, Japan.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tottori Red Cross Hospital, Tottori, 680-8517, Japan.
¹¹ Department of Gastroenterology, Shinbeppu Hospital, 3898 Tsurumi, Beppu-shi, Oita, 874-0833, Japan.
¹² Department of Gastroenterology, Oita Sanai Medical Center, Oita, 870-1151, Japan.
¹³ Clinical Research Center, Kinki University Hospital, Osaka-sayama, 589-8511, Japan.
¹⁴ Center for Clinical Research and Advanced Medicine Establishment, Shiga University of Medical Science, Otsu, 520-2192, Japan.
¹⁵ Second Department of Internal Medicine, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 641-8509, Japan. kitano@wakayama-med.ac.jp.

PMID: 29349694
DOI: 10.1007/s10620-018-4908-8

Abstract

Background: Endoscopic ultrasound-guided rendezvous technique (EUS-RV) has emerged as an effective salvage method for unsuccessful biliary cannulation. However, its application for benign and resectable malignant biliary disorders has not been fully evaluated.

Aims: To assess the efficacy and safety of EUS-RV for benign and resectable malignant biliary disorders.

Methods: This was a multicenter prospective study from 12 Japanese referral centers. Patients who underwent EUS-RV after failed biliary cannulation for biliary disorder were candidates for this study. Inclusion criteria were unsuccessful biliary cannulation for therapeutic endoscopic retrograde cholangiopancreatography with benign and potentially resectable malignant biliary obstruction. Exclusion criteria included unresectable malignant biliary obstruction, inaccessible papillae due to surgically altered upper gastrointestinal anatomy or duodenal stricture, and previous sphincterotomy and/or biliary stent placement. The primary outcome was the technical success rate of biliary cannulation; procedure time, adverse events, and clinical outcomes were secondary outcomes.

Results: Twenty patients were prospectively enrolled. The overall technical success rate and median procedure time were 85% and 33 min, respectively. Guidewire manipulation using a 4-Fr tapered tip catheter contributed to the success in advancing the guidewire into the duodenum. Adverse events were identified in 15% patients, including 2 with biliary peritonitis and 1 mild pancreatitis. EUS-RV did not affect surgical maneuvers or complications associated with surgery, or postoperative course.

Conclusions: EUS-RV may be a safe and feasible salvage method for unsuccessful biliary cannulation for benign or resectable malignant biliary disorders. Use of a 4-Fr tapered tip catheter may improve the overall EUS-RV success rate.

Keywords: Benign and resectable malignant biliary disorders; Endoscopic ultrasonography; Endoscopic ultrasound-guided fine needle aspiration; Endoscopic ultrasound-guided rendezvous technique; Unsuccessful biliary cannulation.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Biliary Tract Neoplasms / diagnostic imaging*
Biliary Tract Neoplasms / pathology
Biliary Tract Neoplasms / surgery*
Catheterization / methods*
Cholangiopancreatography, Endoscopic Retrograde
Endosonography*
Feasibility Studies
Female
Humans
Male
Middle Aged
Prospective Studies
Treatment Outcome
Ultrasonography, Interventional*