“RENDEZ-VOUS” TECHNIQUE FOR PALLIATION OF NEOPLASTIC JAUNDICE: PERSONAL EXPERIENCE

Abstract

Introduction: “Rendez-vous” technique (RV) assume contemporaneous percutaneous transhepatic choledochal drainage (PTCD) and endoscopic (ERCP) approach to make easier biliary cannulation when it fails for anatomic, neoplastic or iatrogenic causes, in subject unresectable at presentation (“not fit for surgery”).

Matherials and methods: Over a 3 years period 618 ERCP were performed in the Service of Digestive Endoscopy in Section of General and Thoracic Surgery, 59 of whom (9%) failed for non-visualization of ampulla of Vater (25%), intradiverticular ampulla (54%) or anatomic defects (21%). Were attempted 44 pre-cut: 14 failed (close biliary stricture), and we proceed to RV.

Results: 11/14 (79%) RV were successful (successful stent insertion was defined as passage of the stent across the stricture) and 3 failure (21%) occurred in close biliary malignant obstruction even to percutaneous transhepatic approach. Only in 28% were registered minor complications (2 post-procedure fever, 1 papillary bleeding post PTE, 1 case mild acute pancreatitis). No mortality procedure related was registered and was not necessary to recur to surgery.

Conclusions: RV is very useful in case of difficult cannulation of biliary tree and after failure of pre-cut. US-guided PTC is easy to perform, with low incidence of complications. Every well experienced team who works on biliopancreatic pathologies may recurs to this technique: even if not much utilized, RV can solves complex cases of biliary stricture.