EUS-GUIDED RENDEZVOUS TECHNIQUE FOR DIFFICULT BILIARY DEEP CANNULATION: BASIC TECHNIQUES AND TECHNICAL INGENUITIES

Abstract

ERCP has been used as a minimally invasive method for evaluation and treatment of biliary diseases. Biliary deep cannulation is the first step of ERCP. Although the success rate of biliary cannulation is reported as high, occasionally it can be difficult even with an “advanced cannulation technique”, such as the precut method. In the EUS-rendezvous method (RV), the bile duct is punctured under the EUS, followed by guidewire insertion through the needle into the duodenum via the bile duct. After that, biliary cannulation is attempted again using the inserted guidewire. EUS-RV has been reported to be useful as a salvage method for difficult biliary cannulation. In this article, we examine the technical aspects of EUS-RV, including an overview of the basic procedure, technical tips, and troubleshooting.