Background and Aims
Because a traditional rendezvous (RV) technique implies stretching of the papilla, possibly leading to post-ERCP pancreatitis, an alternative duodenal RV technique was evaluated. The aim was to assess the effectiveness, safety, and amount of time spent performing duodenal RV versus traditional RV cannulation in orthotopic liver transplantation patients with a T-tube.
We retrospectively reviewed data from a prospective ERCP database held by our university hospital. Twenty patients with a T-tube who had undergone ERCP for biliary adverse events after orthotopic liver transplantation were included. The successful cannulation rate, the amount of time spent performing cannulation, the post-ERCP pancreatitis rate, and hyperamylasemia 24 hours after the procedure were recorded.
Successful cannulation was achieved by the duodenal RV technique in 9 of 10 patients (90%), taking 146 seconds (interquartile range 63-341 seconds) with a short learning curve effect. An unsuccessful duodenal RV procedure occurred because of the angulation of the hydrophilic tip of the guidewire while crossing the papilla, thus preventing cannulation. Successful cannulation was achieved by the traditional RV technique in all cases (N = 11), including the failed duodenal RV technique, taking 374 seconds (interquartile range 320-410 seconds) (P < .05 vs duodenal RV). However, no post-ERCP pancreatitis occurred after using the duodenal RV technique compared with 2 episodes of mild pancreatitis after using the traditional RV technique. Twenty-four hours after the procedure, the median amylasemia level was 84 IU/L (interquartile range 49-105 IU/L) and 265 IU/L (interquartile range 73-2945 IU/L) for the duodenal versus traditional RV techniques, respectively (P = not significant).
In patients with a T-tube after liver transplantation, the duodenal RV technique was not associated with post-ERCP pancreatitis, presumably because of the reduction of stress on the major papilla. Cannulation by using the duodenal RV technique was faster compared with the traditional RV technique. These preliminary data point out the use of the duodenal RV technique as the first option to choose in case of failed cannulation before attempting the traditional RV technique.
Abbreviations:OLT (orthotopic liver transplantation), PEP (post-ERCP pancreatitis), RV (rendezvous)
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Published online: July 31, 2015
Accepted: June 20, 2015
Received: February 19, 2015
DISCLOSURE: All authors disclosed no financial relationships relevant to this article.
If you would like to chat with an author of this article, you may contact Dr Cantù at [email protected]
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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- Post-ERCP pancreatitis after biliary cannulation with traditional rendezvous in patients with T-tubeGastrointestinal EndoscopyVol. 83Issue 6
- PreviewWe read with interest the article by Cantù et al1 about a new technique of duodenal rendezvous for successful biliary cannulation in patients with a T-tube after orthotopic liver transplantation. Although the sample of the study group in this report was very small (10 duodenal, 10 traditional), the authors reported that this technique is relatively safe with regard to the risk of post-ERCP pancreatitis (PEP), and the procedure time is shorter in duodenal rendezvous than in traditional rendezvous.