Parallel cannulation technique at ERCP rendezvous
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1Department of Gastroenterology, Altnagelvin Hospital, Dungiven Road, Londonderry BT47 6SB, Northern Ireland, UK.
Background:
Biliary access at ERCP rendezvous is usually achieved by withdrawing a wire passed antegrade via the accessory channel of the duodenoscope, which is then used for over-the-wire cannulation. The wire is time consuming to maneuver and may be damaged during withdrawal.
Objective:
Description of a simple technique for cannulation at rendezvous that overcomes these problems.
Design:
Observational study.
Setting:
Gastroenterology department of a teaching district general hospital.
Patients:
Fourteen consecutive patients undergoing rendezvous after percutaneous transhepatic cholangiography (PTC).
Intervention:
A transpapillary drain was placed at PTC in 13 patients. At rendezvous, cannulation alongside the drain was attempted with a sphincterotome cannula. After successful cannulation, the drain was progressively withdrawn, allowing retrograde therapeutic intervention.
Results:
In all 13 patients, parallel cannulation was successful, allowing stone removal or biliary stent placement, with cannulation alongside a guidewire in the fourteenth patient. There were no complications except right hypochondrial pain after drain removal.
Conclusions:
Parallel cannulation is straightforward and effective, avoiding the need for guidewire manipulation.
