Brief Article
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World J Gastrointest Endosc. Nov 16, 2013; 5(11): 568-573
Published online Nov 16, 2013. doi: 10.4253/wjge.v5.i11.568
A modified Rendezvous ERCP technique in duodenal diverticulum
Mehmet Odabasi, Mehmet Kamil Yildiz, Haci Hasan Abuoglu, Cengiz Eris, Erkan Ozkan, Emre Gunay, Ali Aktekin, MA Tolga Muftuoglu
Mehmet 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
Author contributions: Odabasi M performed the endoscopic procedures; Yildiz MK, Ozkan E, Eris C, Gunay E, Aktekin A, Muftuoglu MAT and Abuoglu HH contributed to writing the article and reviewing the literature in a comprehensive literature search; Odabasi M designed and prepared the manuscript.
Correspondence to: Mehmet Odabasi, MD, Department of Surgery, Haydarpasa Numune Education and Research Hospital, Tibbiye cad No. 1, Uskudar 34688, Istanbul, Turkey. hmodabasi@gmail.com
Telephone: +90-532-4310630 Fax: +90-216-3360565
Received: August 18, 2013
Revised: October 9, 2013
Accepted: November 2, 2013
Published online: November 16, 2013
Processing time: 92 Days and 13.6 Hours
Abstract

AIM: To postoperative endoscopic retrograde cholangiopancreatography (ERCP) failure, we describe a modified Rendezvous technique for an ERCP in patients operated on for common bile duct stone (CBDS) having a T-tube with retained CBDSs.

METHODS: Five cases operated on for CBDSs and having retained stones with a T-tube were referred from other hospitals located in or around Istanbul city to the ERCP unit at the Haydarpasa Numune Education and Research Hospital. Under sedation anesthesia, a sterile guide-wire was inserted via the T-tube into the common bile duct (CBD) then to the papilla. A guide-wire was held by a loop snare and removed through the mouth. The guide-wire was inserted into the sphincterotome via the duodenoscope from the tip to the handle. The duodenoscope was inserted down to the duodenum with a sphincterotome and a guide-wire in the working channel. With the guidance of a guide-wire, the ERCP and sphincterotomy were successfully performed, the guide-wire was removed from the T-tube, the stones were removed and the CBD was reexamined for retained stones by contrast.

RESULTS: An ERCP can be used either preoperatively or postoperatively. Although the success rate in an isolated ERCP treatment ranges from up to 87%-97%, 5%-10% of the patients require two or more ERCP treatments. If a secondary ERCP fails, the clinicians must be ready for a laparoscopic or open exploration. A duodenal diverticulum is one of the most common failures in an ERCP, especially in patients with an intradiverticular papilla. For this small group of patients, an antegrade cannulation via a T-tube can improve the success rate up to nearly 100%.

CONCLUSION: The modified Rendezvous technique is a very easy method and increases the success of postoperative ERCP, especially in patients with large duodenal diverticula and with intradiverticular papilla.

Keywords: Endoscopic retrograde cholangiopancreatography; Retained stones; Antegrade cannulation; Intradiverticular papilla; T-tube

Core tip: A postoperative endoscopic retrograde cholangiopancreatography (ERCP) is used as a treatment modality for common bile duct stone (CBDS) clearance when a laparoscopic common bile duct exploration has failed or retained stones are discovered after an operation. If a secondary ERCP fails, the clinicians must be ready for a laparoscopic or open exploration. Because of this, different techniques are required to exclude surgical intervention. We describe a modified Rendezvous technique for an ERCP in patients operated on for CBDSs having a T-tube with retained CBDSs and with intradiverticular papilla. The modified Rendezvous technique is a very easy method and increases the success of postoperative ERCP, especially in patients with large duodenal diverticula and with intradiverticular papilla.