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A modified Rendezvous ERCP technique in duodenal diverticulum
Mehmet Odabasi1, Mehmet Kamil Yildiz, Haci Hasan Abuoglu
1Mehmet Odabasi, Mehmet Kamil Yildiz, Haci Hasan Abuoglu, Cengiz Eris, Erkan Ozkan, Emre Gunay, Ali Aktekin, MA Tolga Muftuoglu, Department of Surgery, Haydarpasa Education and Research Hospital, Istanbul, 34688, Turkey.
A modified Rendezvous technique using a T-tube improves success rates for difficult postoperative endoscopic retrograde cholangiopancreatography (ERCP) cases. This method is particularly effective for patients with retained common bile duct stones and duodenal diverticula.
Area of Science:
- Gastroenterology
- Surgical Endoscopy
Background:
- Postoperative endoscopic retrograde cholangiopancreatography (ERCP) can fail, necessitating further interventions.
- Common bile duct stones (CBDS) with retained stones after surgery, especially in patients with T-tubes, present a challenge.
- Duodenal diverticula, particularly with intradiverticular papilla, are a known cause of ERCP failure.
Purpose of the Study:
- To describe a modified Rendezvous technique for successful ERCP in patients with retained CBDS and a T-tube.
- To evaluate the efficacy of this modified technique in challenging postoperative ERCP scenarios.
Main Methods:
- A modified Rendezvous technique was employed in five patients with retained CBDS and T-tubes.
- A guide-wire was inserted via the T-tube into the common bile duct and then to the papilla.
- The guide-wire was retrieved through the mouth and used to facilitate ERCP and sphincterotomy via a duodenoscope.
Main Results:
- The modified Rendezvous technique successfully enabled ERCP and stone removal in all five cases.
- This antegrade cannulation approach via a T-tube significantly increases the success rate for difficult ERCP cases.
- The technique is especially beneficial for patients with large duodenal diverticula and intradiverticular papilla, potentially achieving nearly 100% success.
Conclusions:
- The modified Rendezvous technique is a simple and effective method to improve postoperative ERCP success rates.
- It offers a valuable solution for complex cases involving retained common bile duct stones and T-tubes.
- This technique is particularly advantageous in patients with challenging anatomy like duodenal diverticula.
