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Suto A, Ishido K, Kimura N, Wakiya T, Kikuchi H, Iino C, Igarashi G, Sato S, Sakuraba H, Hakamada K. A case of hepaticojejunal anastomotic obstruction after a living-donor liver transplantation and recanalization using a high-frequency knife under the rendezvous technique. Clin J Gastroenterol 2023; 16:726-731. [PMID: 37170062 DOI: 10.1007/s12328-023-01812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
A 65-year-old woman underwent living-donor liver transplantation (left-lobe graft: GWRW ratio, 0.54) for cirrhosis caused by autoimmune hepatitis. At 68 years, she was diagnosed with obstructive cholangitis due to stricture during a hepaticojejunostomy following impaired liver function. Endoscopic balloon dilation of anastomosis and placement of a plastic stent resulted in improved liver function. However, at 72 years, the patient experienced a flare-up of liver damage. The plastic stent had fallen out, and although endoscopic stenotic dilation was attempted, the anastomotic site was obstructed completely. Therefore, recanalization of the hepaticojejunostomy was attempted using a rendezvous technique. A percutaneous transhepatic biliary drainage tube was inserted through the B3 bile duct, and the complete obstructed anastomosis was confirmed by percutaneous transhepatic and transjejunal approaches. The anastomosis was reopened by excising the scarred tissues from the jejunal side using a 1.5-mm high-frequency knife. A 14-Fr. catheter for the internal fistula tube was percutaneously placed at the opened anastomosis to achieve anastomotic site recanalization. The patient's liver damage improved after the re-internalization, and no symptom recurrence such as obstructive cholangitis developed for 1 year. There are few reports of recanalization of the hepaticojejunostomy with a high-frequency knife. Herein, we report the case with a literature review.
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Affiliation(s)
- Akiko Suto
- Department of Surgery, Odate Municipal General Hospital, 3-1 Yutaka-cho, Odate, Akita, 017-8550, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Keinosuke Ishido
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Norihisa Kimura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hidezumi Kikuchi
- Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Chikara Iino
- Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Go Igarashi
- Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Satoshi Sato
- Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hirotake Sakuraba
- Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Samanta J, Sundaram S, Dhar J, Mane K, Gupta P, Gupta V, Patil P, Sinha SK, Kochhar R, Mehta S. EUS-guided biliary drainage in patients with moderate-severe cholangitis is safe and effective: a multi-center experience. Surg Endosc 2023; 37:298-308. [PMID: 35941304 DOI: 10.1007/s00464-022-09495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with moderate-severe cholangitis require urgent/early biliary drainage and failed endoscopic retrograde cholangiopancreatography (ERCP) warrants use of percutaneous drainage. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved as an effective salvage modality but its safety and efficacy data in moderate-severe cholangitis are limited. PATIENTS AND METHODS All consecutive moderate-severe cholangitis patients, with failed/technically non-feasible ERCP requiring EUS-BD in two tertiary care centers were included. Baseline laboratory and demographic parameters were documented. Technical and clinical success were primary outcome measures. Additionally, effective biliary drainage, adverse events due to procedure, hospital stay, ICU stay, and mortality were noted. RESULTS Of the 49 patients (23 male; 46.9%) presenting with moderate/severe cholangitis, 23 (46.9%) had severe cholangitis. The median Charleston comorbidity index was 7.0 (IQR 2.0). Majority had malignant disease (87.8%) and 25 (51.0%) had inaccessible papilla. Technical success was achieved in 48 cases (98.0%), while clinical success with improvement of cholangitis was noted in 44 of 48 cases (91.7%). Effective biliary drainage was noted in 85.4% (41/48) cases. Adverse events in the form of mostly bleeding and bile leak were noted in 5 cases (10.2%) but managed conservatively. Distal obstruction exhibited significantly better clinical success (100% vs. 78.9%; p = 0.02) than hilar obstruction. Severe cholangitis had significantly lower clinical success (81.8% vs. 100%; p = 0.04) than moderate cholangitis. CONCLUSION EUS-BD can be a safe and effective alternative option for patients with moderate to severe cholangitis, even with significant pre-morbid conditions, with acceptable adverse events rate.
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Affiliation(s)
- Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India.
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jahnvi Dhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Kiran Mane
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Gupta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Vikas Gupta
- Department of GI Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Shaesta Mehta
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Oelrich R, Kjoelbye JS, Rosenkrantz O, Barfod C. Rendezvous between ambulances and prehospital physicians in the Capital Region of Denmark: a descriptive study. Scand J Trauma Resusc Emerg Med 2022; 30:52. [PMID: 36221109 PMCID: PMC9552492 DOI: 10.1186/s13049-022-01040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a two-tier Emergency Medical Services response system with ambulances and physician-staffed rapid response vehicles, both units are ideally dispatched simultaneously when a physician is needed. However, when advanced resources are dispatched secondarily, a meeting point (rendezvous) is established to reduce time to advanced care. This study aims to assess the extent of rendezvous tasks, patient groups involved and physician contribution when rendezvous is activated between the primary ambulances and rapid response vehicles in the Capital Region of Denmark. METHODS We analysed prehospital electronic patient record data from all rendezvous cases in the Capital Region of Denmark in 2018. Variables included the number of times rendezvous was activated, patient demographics, dispatch criteria, on-scene diagnosis, and prehospital treatment. RESULT Ambulances requested rendezvous 2340 times, corresponding to 1.3% of all ambulance tasks and 10.7% of all rapid response vehicle dispatches. The most frequently used dispatch criterion was unclear problem n = 561 (28.8%), followed by cardiovascular n = 439 (22.5%) and neurological n = 392 (20.1%). The physician contributed with technical skills like medication n = 760 (39.0%) and advanced airway management n = 161 (8.3%), as well as non-technical skills like team leading during advanced life support n = 152 (7.8%) and decision to end futile treatment and death certificate issuance n = 73 (3.7%). CONCLUSION Rendezvous between ambulances and physician-staffed rapid response vehicles was activated in 1.3% of all ambulance cases corresponding to 10.7% of all RRV dispatches in 2018. The three largest patient groups in rendezvous presented cardiovascular, neurological, and respiratory problems. The prehospital physician contributed with technical skills like medication and advanced airway management as well as non-technical skills like team leading during advanced life support and ending futile treatment. The high percentage of dispatch criterion unclear problem illustrates the challenge of precise dispatch and optimal use of prehospital resources. Therefore, it seems necessary to have a safe and rapid rendezvous procedure to cope with this uncertainty.
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Affiliation(s)
- Roselil Oelrich
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.
| | - Julie Samsoee Kjoelbye
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Oscar Rosenkrantz
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark
| | - Charlotte Barfod
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Donatelli G, Cereatti F, Dhumane P, Antonelli G, Dumont JL, De Palma GD, Dagher I, Derhy S. Long-term Outcomes of Combined Endoscopic-Radiological Approach for the Management of Complete Transection of the Biliary Tract. J Gastrointest Surg 2022; 26:1873-1880. [PMID: 35668228 DOI: 10.1007/s11605-022-05365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Complete transection of the main bile duct (CTMD) is a major complication during hepato-bilio-pancreatic (HBP) surgery and is associated with high morbidity and mortality. In recent years, a combined endoscopic-radiological approach (CERA) for minimally invasive treatment of CTMD has been introduced, but evidence on its long-term outcomes is limited. Our aim is to report efficacy, safety, and long-term outcomes of CERA for the management of post-surgical CTMD in a tertiary referral center. METHODS All consecutive patients referred for CTMD after HBP surgery between February 2012 and January 2021 were included in this study. CERA was first performed to re-establish biliary tree continuity, and then multiple biliary plastic stents were deployed to guarantee biliary tree reconstruction. Anthropometric, clinical, procedural (endoscopic/radiologic/surgical), and follow-up data were collected and analyzed. Each lesion was classified according to Strasberg classification. RESULTS Overall, 60 patients (age 60.5 years, range 28-91), 38 F (61.7%), underwent CERA. Mean interval from surgery to endoscopic treatment was 13.2 days. Mean treatment duration was 526 days (SD ± 415) with a median number of 8 endoscopic sessions (range 1-33). Mean length of the biliary defect was 17.6 mm (SD ± 11.5). Long-term clinical success was achieved in 33/49 (67.3%) of patients. Treatment failure was experienced in 16/49 (32.7%) patients, while after an average follow-up of 41 months, stricture recurrence was observed in 3/36 (8.3%) patients. CONCLUSIONS CERA is a minimally invasive and effective technique to re-establish the continuity of the biliary tract after CTMD, achieving permanent restoration in over half of treated patients.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé Des Peupliers, Ramsay Santé, 8 Place de L'Abbé G. Hénocque, 75013, Paris, France. .,Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé Des Peupliers, Ramsay Santé, 8 Place de L'Abbé G. Hénocque, 75013, Paris, France.,Department of Gastroenterology and Digestive Endoscopy, Castelli Hospital, Ariccia (Rm), Italy
| | - Parag Dhumane
- Unité d'Endoscopie Interventionnelle, Hôpital Privé Des Peupliers, Ramsay Santé, 8 Place de L'Abbé G. Hénocque, 75013, Paris, France.,Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra(w), Mumbai, India
| | - Giulio Antonelli
- Department of Gastroenterology and Digestive Endoscopy, Castelli Hospital, Ariccia (Rm), Italy.,Department of Anatomical, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, HistologicalRome, Italy
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé Des Peupliers, Ramsay Santé, 8 Place de L'Abbé G. Hénocque, 75013, Paris, France
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Serge Derhy
- Unité de Radiologie Interventionnelle, Hôpital Privé Des Peupliers, Ramsay Santé, Paris, France
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Tsou YK, Pan KT, Lee MH, Lin CH. Endoscopic salvage therapy after failed biliary cannulation using advanced techniques: A concise review. World J Gastroenterol 2022; 28:3803-3813. [PMID: 36157537 PMCID: PMC9367240 DOI: 10.3748/wjg.v28.i29.3803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/15/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) begins with successful biliary cannulation. However, it is not always be successful. The failure of the initial ERCP is attributed to two main aspects: the papilla/biliary orifice is endoscopically accessible, or it is inaccessible. When the papilla/biliary orifice is accessible, bile duct cannulation failure can occur even with advanced cannulation techniques, including double guidewire techniques, transpancreatic sphincterotomy, needle-knife precut papillotomy, or fistulotomy. There is currently no consensus on the next steps of treatment in this setting. Therefore, this review aims to propose and discuss potential endoscopic options for patients who have failed ERCP due to difficult bile duct cannulation. These options include interval ERCP, percutaneous-transhepatic-endoscopic rendezvous procedures (PTE-RV), and endoscopic ultrasound-assisted rendezvous procedures (EUS-RV). The overall success rate for interval ERCP was 76.3% (68%-79% between studies), and the overall adverse event rate was 7.5% (0-15.9% between studies). The overall success rate for PTE-RV was 88.7% (80.4%-100% between studies), and the overall adverse event rate was 13.2% (4.9%-19.2% between studies). For EUS-RV, the overall success rate was 82%-86.1%, and the overall adverse event rate was 13%-15.6%. Because interval ERCP has an acceptably high success rate and lower adverse event rate and does not require additional expertise, facilities, or other specialists, it can be considered the first choice for salvage therapy. EUS-RV can also be considered if local experts are available. For patients in urgent need of biliary drainage, PTE-RV should be considered.
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Affiliation(s)
- Yung-Kuan Tsou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuang-Tse Pan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Mu Hsien Lee
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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de Benito Sanz M, Carbajo AY, Sanchez-Ocana R, Chavarría C, de la Serna-Higuera C, Perez-Miranda M. Combined endoscopic retrograde and endosonography-guided (CERES) cholangiography for interventional repair of transected bile ducts after cholecystectomy: treatment approaches and outcomes. Surg Endosc 2021; 36:2197-2207. [PMID: 34816304 DOI: 10.1007/s00464-021-08809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Post-cholecystectomy transected bile ducts (TBDs) are not amenable to standard endoscopic management. Combined ERCP and endosonography (CERES) including EUS-guided hepaticoenterostomy enhance therapeutic biliary endoscopy. CERES treatment of post-cholecystectomy TBDs is evaluated. METHODS Among 165 consecutive patients who underwent ERCP for post-cholecystectomy bile duct injury (Amsterdam A/B/C/D grades [%] = 47/30/7/16) between January 2009-November 2020 at a tertiary-care center, 10/26 (38%) with TBDs (6 female; 32-92 years old) underwent CERES before attempted endoscopic repair (staged CERES, n = 7) or surgical repair (preoperative CERES, n = 1), or as destination therapy (definitive CERES, n = 2). Short-term clinical success rate, final clinical success rate and comprehensive complication index (CCI) were retrospectively determined. Additionally, number of follow-up procedures, adverse events, recurrences, final patency grades and definitive cure rate were determined in patients with staged CERES. RESULTS Index CERES (hepaticogastrostomy, 60%; hepaticoduodenostomy, 40%) achieved bile leak and jaundice resolution in 10 patients (100% short-term clinical success rate). Overall, 9/10 patients maintained good/excellent biliary drainage over a median 3.2 years without any unplanned percutaneous/surgical procedures (90% final clinical success rate; median CCI = 8.7). Staged CERES using recanalization (n = 6) or diversion (n = 1) strategies achieved Grade A patency in 5/7 (71%) patients after a median of 2 follow-up procedures over a median 12-month treatment period; 2 failed recanalization patients were salvaged by indefinite hepaticoenterostomy stent or elective surgery, respectively. Among staged CERES, 2 treatment-related cholangitis occurred (29%) and 2 recurring strictures (29%) developed over a median 8.4 year follow-up; recurring strictures were endoscopically remodeled (n = 1) or indefinitely stented (n = 1); final Grade A/B biliary patency was achieved in 5/7 (71%) and definitive cure in 4/7 (57%). CONCLUSIONS CERES controls acute symptoms in selected post-cholecystectomy TBD patients allowing subsequent staged endoscopic therapy. Definitive cure or long-term biliary drainage is possible in most cases and elective surgery can be facilitated in the remainder.
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Affiliation(s)
- Marina de Benito Sanz
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Ana Y Carbajo
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Ramon Sanchez-Ocana
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Carlos Chavarría
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Carlos de la Serna-Higuera
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Manuel Perez-Miranda
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain.
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Bequis A, Gonzalez M, Fernandez Aramburu J, Huespe P, Duran S, Hyon SH, Vaccaro CA. Fluoroscopy and endoscopy-guided transanastomotic rendezvous: a novel technique for recanalization of a completely obstructed colorectal anastomosis. Int J Colorectal Dis 2021; 36:627-631. [PMID: 33057895 DOI: 10.1007/s00384-020-03781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal anastomotic stricture is a frequent complication that may affect up to 30% of patients. However, a complete obstruction is rare. Endoscopic balloon dilation is the first-line therapy, but it invariably requires being able to cross the stricture with the dilation device. When this is not possible, surgical revision is the alternative, but it is associated with higher morbidity. CASE PRESENTATION A 76-year-old male patient underwent an urgent high anterior resection with transverse loop colostomy for an occlusive high rectal tumor. On postoperative day 8, he presented with anastomotic leakage and abscess formation, requiring percutaneous drainage. Ten months after surgery, a colonoscopy revealed a complete stricture of the anastomosis, refractory to negotiation of a guide wire, thus precluding balloon dilation. Hence, a modified rendezvous technique was planned. Simultaneously, a flexible endoscope and a rigid rectoscope were progressed through the distal loop colostomy, and the anus, respectively. A needle device was introduced through the rectoscope and used to pierce the colonic stump. A guide wire was progressed, and the stricture was dilated with a controlled radial expansion balloon catheter. Finally, a 12-Fr Foley catheter was left through the anastomosis. A total of three endoscopic balloon dilation sessions were completed, and successful colostomy reversal was carried out 10 days after the last session. CONCLUSION Fluoroscopy-endoscopy-guided recanalization is an effective and safe treatment option for complete colorectal anastomotic stricture.
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Affiliation(s)
- Agustina Bequis
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Marcos Gonzalez
- Division of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Julian Fernandez Aramburu
- Division of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Huespe
- Division of Image Guided Minimally Invasive Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sebastian Duran
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sung Ho Hyon
- Division of Image Guided Minimally Invasive Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carlos A Vaccaro
- Division of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Brañes A, Pérez G. Laparoendoscopic rendezvous procedure in a patient with situs inversus totalis: A case report and review of the literature. Clin Case Rep 2020; 8:2595-2599. [PMID: 33363786 PMCID: PMC7752348 DOI: 10.1002/ccr3.3240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022] Open
Abstract
Situs inversus totalis patients may be associated with difficulties in the diagnosis and treatment of surgical diseases. This case suggests that laparoendoscopic rendezvous procedure could be associated with a lower morbidity and length of hospital stay.
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Affiliation(s)
- Alejandro Brañes
- Digestive Surgery DepartmentSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Gustavo Pérez
- Digestive Surgery DepartmentSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
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Harewood S, Mencia MM, Harnarayan P. The rendezvous technique for the treatment of ipsilateral femoral neck and shaft fractures: A case series. Trauma Case Rep 2020; 29:100346. [PMID: 32793794 PMCID: PMC7413999 DOI: 10.1016/j.tcr.2020.100346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
Concomitant ipsilateral femoral neck and shaft fractures are uncommon high-energy injuries characteristically occurring in young adults. Between 75 and 100% of these injuries occur in association with polytrauma to other organ systems. Associated femoral neck fractures are typically undisplaced, occurring in 2–9% of all femoral shaft fractures. These injuries present both technical and infrastructural challenges particularly in a low resource environment. Several methods of treatment have been used to successfully treat these fractures but there exists no consensus about the optimal management strategy. The “rendezvous” technique using dual implants in an overlapping fashion has been proposed as one method to treat these fractures. We present three cases of ipsilateral hip and femoral shaft fractures which were satisfactorily treated using this technique. The “rendezvous” technique is a simple method, with a good clinical outcome and a low complication rate that can be used to treat ipsilateral femoral neck and shaft fractures.
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Affiliation(s)
- Seun Harewood
- Department of Surgery, Scarborough General Hospital, Tobago, Trinidad and Tobago
| | - Marlon M. Mencia
- Department of Clinical Surgical Sciences, University of the West Indies, Trinidad and Tobago
- Corresponding author at: Bungalow 5, Department of Clinical Surgical Sciences, Port of Spain General Hospital, Trinidad and Tobago.
| | - Patrick Harnarayan
- Department of Clinical Surgical Sciences, University of the West Indies, Trinidad and Tobago
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Winder JS, Juza RM, Alli VV, Rogers AM, Haluck RS, Pauli EM. Concomitant laparoscopic cholecystectomy and antegrade wire, rendezvous cannulation of the biliary tree may reduce post-ERCP pancreatitis events. Surg Endosc 2019; 34:3216-3222. [PMID: 31489502 DOI: 10.1007/s00464-019-07074-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION For patients with a gallbladder in situ, choledocholithiasis is a common presenting symptom. Both two-session endoscopic retrograde cholangiopancreatography (ERCP) and subsequent cholecystectomy (CCY) and single-stage (simultaneous CCY/ERCP) have been described. We utilize an antegrade wire, rendezvous cannulation (AWRC) technique to facilitate ERCP during CCY. We hypothesized that AWRC would eliminate episodes of post-ERCP pancreatitis (PEP). METHODS An IRB approved, retrospective review of patients who underwent ERCP via AWRC for choledocholithiasis during CCY was performed. Patient characteristics, pre/postoperative laboratory values, complications, and readmissions were reviewed. AWRC was conducted during laparoscopic or open CCY for evidence of choledocholithiasis with or without preoperative biliary pancreatitis or cholangitis. Following confirmatory intraoperative cholangiogram, a flexible tip guidewire was inserted antegrade into the cystic ductotomy, through the bile duct across the ampulla and retrieved in the duodenum with a duodenoscope. Standard ERCP maneuvers to clear the bile duct are then performed over the wire. RESULTS Thirty-seven patients (27 female, age 19-77, BMI 21-50 kg/m2) underwent intraoperative ERCP via AWRC technique during CCY. Seventeen underwent CCY for acute cholecystitis. Fifteen patients underwent transgastric ERCP in the setting of previous Roux-en-Y gastric bypass. Mean total operative time was 214 min. Mean ERCP time was 31 min. Thirty-three patients had biliary stents placed. There were no cannulations or injections of the pancreatic duct. There were no intraoperative complications associated with the ERCP and no patients developed PEP. Three patients developed a postoperative subhepatic abscess requiring drainage. CONCLUSION AWRC is a useful technique for safe and efficient bile duct cannulation for therapeutic ERCP in the setting of choledocholithiasis at the time of CCY. Despite supine (rather than the traditional prone) positioning, total ERCP times were short and we eliminated any manipulation of the pancreatic duct. No patients in our series developed PEP or post-sphincterotomy bleeding.
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Affiliation(s)
- Joshua S Winder
- Division of Minimally Invasive and Bariatric Surgery, Department of General Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033, USA
| | - Ryan M Juza
- Division of Minimally Invasive and Bariatric Surgery, Department of General Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033, USA
| | - Vamsi V Alli
- Division of Minimally Invasive and Bariatric Surgery, Department of General Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033, USA
| | - Ann M Rogers
- Division of Minimally Invasive and Bariatric Surgery, Department of General Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033, USA
| | - Randy S Haluck
- Division of Minimally Invasive and Bariatric Surgery, Department of General Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033, USA
| | - Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of General Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033, USA.
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Meek J, Fletcher S, Crumley K, Culp WC, Meek M. Percutaneous rendezvous technique for the management of a bile duct injury. Radiol Case Rep 2017; 13:175-178. [PMID: 29487652 PMCID: PMC5826696 DOI: 10.1016/j.radcr.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 11/20/2022] Open
Abstract
The rendezvous technique typically involves combined efforts of interventional radiology, endoscopy, and surgery. It can be done solely percutaneously, whereby the interventionalist gains desired access to one point in the body by approaching it from two different access sites. We present the case of a woman who underwent cholecystectomy complicated by a bile duct injury. A percutaneous rendezvous procedure enabled placement of an internal-external drain from the intrahepatic ducts through the biloma and distal common bile duct and into the duodenum. Thus, a percutaneous rendezvous technique is feasible for managing a bile duct injury when endoscopic retrograde cholangio-pancreatography or percutaneous transhepatic cholangiogram alone has been unsuccessful.
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Affiliation(s)
- James Meek
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 556, Little Rock, AR 72205, USA
| | - Savannah Fletcher
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 556, Little Rock, AR 72205, USA
| | - Kristen Crumley
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 556, Little Rock, AR 72205, USA
| | - W C Culp
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 556, Little Rock, AR 72205, USA
| | - Mary Meek
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 556, Little Rock, AR 72205, USA
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12
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Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of therapy for pancreatobiliary diseases. While ERCP is safe and highly effective in the general population, the procedure remains challenging or impossible in patients with surgically altered anatomy (SAA). Endoscopic ultrasound (EUS) allows transmural access to the bile or pancreatic duct (PD) prior to ductal drainage using ERCP-based techniques. Also known as endosonography-guided cholangiopancreatography (ESCP), the procedure provides multiple advantages over overtube-assisted enteroscopy ERCP or percutaneous or surgical approaches. However, the procedure should only be performed by endoscopists experienced in both EUS and ERCP and with the proper tools. In this review, various EUS-guided diagnostic and therapeutic drainage techniques in patients with SAA are examined. Detailed step-by-step procedural descriptions, technical tips, feasibility, and safety data are also discussed.
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Affiliation(s)
| | - Linda S Lee
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Yu A, Huang Q, Liu CH, Lin XS, Xie F. Rendezvous technique for cholecysto-choledocholithiasis during laparoscopic cholecystectomy: A systemic review and meta-analysis. Shijie Huaren Xiaohua Zazhi 2016; 24:2563-2570. [DOI: 10.11569/wcjd.v24.i16.2563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To systematically evaluate the efficacy and safety of the rendezvous technique for cholecysto-choledocholithiasis during laparoscopic cholecystectomy (LC).
METHODS: From February 31, 2006 to February 31, 2016, RCTs evaluating the rendezvous technique for cholecysto-choledocholithiasis during laparoscopic cholecystectomy were retrieved from Cochrane Library, PubMed, Embase, CBM, CNKI database, Wanfang and VIP database. The data were extracted and analyzed using the RevMan 5.3.5 software.
RESULTS: Six RCTs were enrolled in the meta-analysis. Among 616 patients analyzed, the rendezvous technique was used in 307 patients and POERCP + LC in 309 patients. The results of meta-analysis showed significant differences between the rendezvous technique group and POERCP + LC group regarding stone clearance rate (OR = 2.24, 95%CI: 1.26-4.65, P = 0.08), cannulation failure rate (OR = 0.39, 95%CI: 0.18-0.83, P = 0.01), and overall morbidity (OR = 0.41, 95%CI: 0.22-0.75, P = 0.004). Sub-group analysis of morbidity also revealed significant differences between the rendezvous technique group and POERCP + LC group regarding post-ERCP pancreatitis (OR = 0.15, 95%CI: 0.05-0.44, P = 0.0005) and hyperamylasemia (OR = 0.18, 95%CI: 0.09-0.36, P = 0.0001), but the differences in the complication morbidity of LC and conversions rate were not significant (P > 0.05).
CONCLUSION: The rendezvous technique is superior to POERCP + LC in terms of stone clearance, cannulation success, complication morbidity of ERCP and hospital stay. Large, multicenter prospective randomized controlled trials are still needed to confirm the findings of this meta-analysis.
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14
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Khan MA, Akbar A, Baron TH, Khan S, Kocak M, Alastal Y, Hammad T, Lee WM, Sofi A, Artifon EL, Nawras A, Ismail MK. Endoscopic Ultrasound-Guided Biliary Drainage: A Systematic Review and Meta-Analysis. Dig Dis Sci 2016; 61:684-703. [PMID: 26518417 DOI: 10.1007/s10620-015-3933-0] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/13/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Variable success and adverse event rates have been reported for endoscopic ultrasound-guided biliary drainage (EUS-BD) utilizing either extrahepatic or intrahepatic approach. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of EUS-BD and to compare the two approaches and transluminal methods of EUS-BD. METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus from January 2001 through January 5, 2015, to identify studies reporting technical success and adverse events of EUS-BD. A sample size of more than 20 patients was a further criterion. Weighted pooled rate (WPR) for technical success and post-procedure complications was calculated for overall studies and predefined subgroups. Pooled odds ratios were calculated for technical success and adverse events for two approaches and transluminal methods of EUS-BD for distal common bile duct (CBD) strictures. RESULTS The WPR with 95% confidence interval (CI) for technical success and post-procedure adverse events was 90% (86, 93%) and 17% (13, 22%), respectively, with considerable heterogeneity (I(2) = 77%). For high-quality studies, the WPR for technical success was 94% (91, 96 %), I(2) = 0% and WPR for post-procedure adverse event was 16% (12, 19%), I(2) = 39%. In meta-regression model, distal CBD stricture and transpapillary drainage were associated with higher technical success and intrahepatic access route was associated with higher adverse event rate. There was no difference in technical success using either approach OR 1.27 (0.52, 3.13), I(2) = 0% or transluminal method OR 1.32 (0.51, 3.38), I(2) = 0%. However, the extrahepatic approach appeared significantly safer as compared to the intrahepatic approach OR 0.35 (0.19, 0.67), I(2) = 27%. Likewise, choledochoduodenostomy was found to have less adverse events as compared to hepaticogastrostomy, OR 0.40 (0.18, 0.87), I (2) = 0%. CONCLUSION In cases of failure of traditional ERC to achieve biliary drainage, EUS-BD appears to be an emerging therapeutic modality with a cumulative success rate of 90% and cumulative adverse events rate of 17%. Randomized controlled trials are required to further evaluate the efficacy and safety of the procedure along with the comparison to traditional modalities like percutaneous transhepatic biliary drainage.
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15
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Guedes HG, Lopes RI, Oliveira JFD, Artifon ELDA. Reality named endoscopic ultrasound biliary drainage. World J Gastrointest Endosc 2015; 7:1181-1185. [PMID: 26504507 PMCID: PMC4613807 DOI: 10.4253/wjge.v7.i15.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/01/2015] [Accepted: 09/18/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.
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Abstract
Endoscopic retrograde cholangiography (ERCP) is widely used as a first-line therapy for biliary drainage. ERCP occasionally fails owing to anatomical or technical problems, despite high reported success rates. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has recently emerged as an effective alternative biliary drainage method after unsuccessful ERCP. EUS-BD can be essentially divided into 3 different techniques—(1) EUS-guided transluminal biliary drainage including choledocoduodenostomy and hepaticogastrostomy, (2) EUS-rendezvous technique, and (3) EUS-antegrade approach. Here, we focus on the current status of EUS-BD in light of these 3 different techniques.
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Affiliation(s)
- Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Shinpei Doi
- First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Ichiro Yasuda
- First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
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Chang JH, Lee IS, Chun HJ, Choi JY, Yoon SK, Kim DG, You YK, Choi MG, Han SW. Comparative study of rendezvous techniques in post-liver transplant biliary stricture. World J Gastroenterol 2012; 18:5957-64. [PMID: 23139613 PMCID: PMC3491604 DOI: 10.3748/wjg.v18.i41.5957] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/02/2012] [Accepted: 05/05/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the usefulness of a new rendezvous technique for placing stents using the Kumpe (KMP) catheter in angulated or twisted biliary strictures.
METHODS: The rendezvous technique was performed in patients with a biliary stricture after living donor liver transplantation (LDLT) who required the exchange of percutaneous transhepatic biliary drainage catheters for inside stents. The rendezvous technique was performed using a guidewire in 19 patients (guidewire group) and using a KMP catheter in another 19 (KMP catheter group). We compared the two groups retrospectively.
RESULTS: The baseline characteristics did not differ between the groups. The success rate for placing inside stents was 100% in both groups. A KMP catheter was easier to manipulate than a guidewire. The mean procedure time in the KMP catheter group (1012 s, range: 301-2006 s) was shorter than that in the guidewire group (2037 s, range: 251-6758 s, P = 0.022). The cumulative probabilities corresponding to the procedure time of the two groups were significantly different (P = 0.008). The factors related to procedure time were the rendezvous technique method, the number of inside stents, the operator, and balloon dilation of the stricture (P < 0.05). In a multivariate analysis, the rendezvous technique method was the only significant factor related to procedure time (P = 0.010). The procedural complications observed included one case of mild acute pancreatitis and one case of acute cholangitis in the guidewire group, and two cases of mild acute pancreatitis in the KMP catheter group.
CONCLUSION: The rendezvous technique involving use of the KMP catheter was a fast and safe method for placing inside stents in patients with LDLT biliary stricture that represents a viable alternative to the guidewire rendezvous technique.
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18
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Chang JH, Lee IS, Chun HJ, Choi JY, Yoon SK, Kim DG, You YK, Choi MG, Choi KY, Chung IS. Usefulness of the rendezvous technique for biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis. Gut Liver 2010; 4:68-75. [PMID: 20479915 DOI: 10.5009/gnl.2010.4.1.68] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 02/04/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Replacement of a percutaneous transhepatic biliary drainage (PTBD) catheter with inside stents using endoscopic retrograde cholangiography is difficult in patients with angulated or twisted biliary anastomotic stricture after living donor liver transplantation (LDLT). We evaluated the usefulness and safety of the rendezvous technique for the management of biliary stricture after LDLT. METHODS Twenty patients with PTBD because of biliary stricture after LDLT with duct-to-duct anastomosis underwent the placement of inside stents using the rendezvous technique. RESULTS Inside stents were successfully placed in the 20 patients using the rendezvous technique. The median procedure time was 29.6 (range, 7.5-71.8) minutes. The number of inside stents placed was one in 12 patients and two in eight patients. One mild acute pancreatitis and one acute cholangitis occurred, which improved within a few days. Inside stent related sludge or stone was identified in 12 patients during follow-up. Thirteen patients achieved stent-free status for a median of 281 (range, 70-1,351) days after removal of the inside stents. CONCLUSIONS The rendezvous technique is a useful and safe method for the replacement of PTBD catheter with inside stent in patients with biliary stricture after LDLT with duct-to-duct anastomosis. The rendezvous technique could be recommended to patients with angulated or twisted strictures.
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Affiliation(s)
- Jae Hyuck Chang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Greca GL, Barbagallo F, Blasi MD, Chisari A, Lombardo R, Bonaccorso R, Latteri S, Stefano AD, Russello D. Laparo-endoscopic “ Rendezvous” to treat cholecysto-choledocolithiasis: Effective, safe and simplifies the endoscopist’s work. World J Gastroenterol 2008; 14:2844-50. [PMID: 18473408 PMCID: PMC2710725 DOI: 10.3748/wjg.14.2844] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP).
METHODS: Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized “tailored” RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire.
RESULTS: The feasibility was 97.5% and the effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone’s recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the cases.
CONCLUSION: Simultaneous RV carries high effectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.
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