Korean Journal of Gastrointestinal Endoscopy 2007;34(3): 138-142.
경피 경간 담관 배액관 유도하의 담관 내 삽관: 수정 랑데부 술기
김홍주·최선형*·박정호·박동일·조용균·손정일·전우규·김병익
성균관대학교 의과대학 강북삼성병원 내과학교실, *방사선과학교실
Bile Duct Cannulation Guided by a Percutaneous Transhepatic Biliary Drainage (PTBD) Tube: Modified Rendezvous Procedure
Hong Joo Kim, M.D., Seon Hyeong Choi, M.D.*, Jung Ho Park, M.D., Dong Il Park, M.D., Yong Kyun Cho, M.D., Chong Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.
Departments of Internal Medicine and *Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
Abstract
Background/Aims: To describe a simple and useful modification of the rendezvous technique using a PTBD tube as guidance. Methods: From January 2005 to August 2006, a total of 436 ERCPs were performed. A diagnosis of choledocholithiasis was made in 235 cases. Deep cannulation of the bile duct using standard techniques was unsuccessful in 27 patients (11.5%). A precut papillotomy led to successful cannulation in 16 out of these 27 patients (59.3%). The remaining 11 patients (40.7%) underwent PTBD with the tube tip placed in the second portion of the duodenum. Bile duct cannulation was attempted with the guidance of a PTBD tube in 9 cases. In the other 2 cases, the transduodenal approach was impossible due to a previous Billroth II operation. Results: Bile duct cannulation guided by a PTBD tube, which is also known as a modified rendezvous procedure, was successful in 9 out of 11 patients (81.8%). Deep cannulation of the bile duct was achieved in 100% of patients, who could be treated by endoscopy. There were 7 cases of transient hyperamylasemia (77.8%) but no procedure-related major complications or mortality. Conclusions: Bile duct cannulation guided by a PTBD tube in patients with choledocholithiasis can be recommended when ERCP is unsuccessful using the standard technique. (Korean J Gastrointest Endosc 2007;34:138142)
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