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Endoscopic Ultrasound-guided Rendezvous Technique after Failed Endoscopic Retrograde Cholangiopancreatography: Which Approach Route Is the Best?

OBJECTIVE: The endoscopic ultrasound-guided rendezvous technique (EUS-RV) is a salvage method for failed selective biliary cannulation. Three puncture routes have been reported, with many comparisons between the intra-hepatic and extra-hepatic biliary ducts. We used the trans-esophagus (TE) and tran...

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Detalles Bibliográficos
Autores principales: Okuno, Nozomi, Hara, Kazuo, Mizuno, Nobumasa, Hijioka, Susumu, Tajika, Masahiro, Tanaka, Tsutomu, Ishihara, Makoto, Hirayama, Yutaka, Onishi, Sachiyo, Niwa, Yasumasa, Yamao, Kenji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society of Internal Medicine 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742383/
https://www.ncbi.nlm.nih.gov/pubmed/28943555
http://dx.doi.org/10.2169/internalmedicine.8677-16
Descripción
Sumario:OBJECTIVE: The endoscopic ultrasound-guided rendezvous technique (EUS-RV) is a salvage method for failed selective biliary cannulation. Three puncture routes have been reported, with many comparisons between the intra-hepatic and extra-hepatic biliary ducts. We used the trans-esophagus (TE) and trans-jejunum (TJ) routes. In the present study, the utility of EUS-RV for biliary access was evaluated, focusing on the approach routes. METHODS AND PATIENTS: In 39 patients, 42 puncture routes were evaluated in detail. EUS-RV was performed between January 2010 and December 2014. The patients were prospectively enrolled, and their clinical data were retrospectively collected. RESULTS: The patients' median age was 71 (range 29-84) years. The indications for endoscopic retrograde cholangiopancreatography (ERCP) were malignant biliary obstruction in 24 patients and benign biliary disease in 15. The technical success rate was 78.6% (33/42) and was similar among approach routes (p=0.377). The overall complication rate was 16.7% (7/42) and was similar among approach routes (p=0.489). However, mediastinal emphysema occurred in 2 TE route EUS-RV patients. No EUS-RV-related deaths occurred. CONCLUSION: EUS-RV proved reliable after failed ERCP. The selection of the appropriate route based on the patient's condition is crucial.