Modified rendezvous intrahepatic bile duct cannulation technique to pass a PTBD catheter in ERCP

Figure 1 Abdominal computed tomography. A: Diffuse low-attenuated wall thickening of the gallbladder; B: Magnetic resonance cholangiopancreatography reveals a severe segmental stricture of the right intrahepatic bile duct with mild upstream duct dilatation.

Figure 2 Endoscopic retrograde cholangiopancreatography shows severe narrowing of the right proximal intrahepatic bile duct and slight narrowing of the common hepatic duct.

Figure 3 Endoscopic images. A: A C2 catheter in the duodenum; B: A view of end-to-end contact between the tips of the guidewire-preloaded sphincterotome and C2 catheter (arrows) at the ampulla’s orifice.

Figure 4 Fluoroscopic views. A: The guidewire passed into the right intrahepatic bile duct through the C2 catheter after end-to-end contact (arrows); B: Simultaneously, the sphincterotome was pushed into the common bile duct and the C2 catheter was pulled out (arrows); C: Finally, the C2 catheter was removed.