Percutaneous-transhepatic-endoscopic rendezvous procedures are effective and safe in patients with refractory bile duct obstruction. Issue 3 (April 2019)

• Record Type: Journal Article
• Authors: Bokemeyer, Arne; Müller, Friederike; Niesert, Hannah; Brückner, Markus; Bettenworth, Dominik; Nowacki, Tobias; Beyna, Torsten; Ullerich, Hansjörg; Lenze, Frank
• Is Part Of: United European Gastroenterology journal. Volume 7:Issue 3(2019)
• Page Start: 397
• Page End: 404
• Publication Date: 2019-04
• Subjects: Cholangiography -- endoscopic rendezvous procedures -- percutaneous cholangiography -- percutaneous-transhepatic-endoscopic rendezvous techniques -- safety; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640619825949
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: Percutaneous-transhepatic-endoscopic rendezvous procedures (PTE-RVs) are rescue approaches used to facilitate biliary drainage. Objective: The objective of this article is to evaluate the safety and the technical success of PTE-RVs in comparison with those of percutaneous transhepatic cholangiographies (PTCs). Methods: Percutaneous procedures performed over a 10-year period were retrospectively analyzed in a single-center cohort. Examinations were performed because of a previous or expected failure of standard endoscopic methods including endoscopic retrograde cholangiography (ERC) or balloon-assisted ERC to achieve biliary access. Results: In total, 553 percutaneous procedures including 163 PTE-RVs and 390 PTCs were performed. Overall, 71.3% of the patients suffered from malignant disease with pancreas-carcinoma (32.8%) and cholangio-carcinoma (19.0%) as the most frequent, while 28.7% of the patients suffered from benign disease. Many patients had a postoperative change in bowel anatomy (50.8%). PTC had a higher technical success rate (89.7%); however, the technical success rate of PTE-RVs was still high (80.4%; p < 0.003). Overall complications occurred in 23.5% of all procedures. Significantly fewer complications occurred after performing PTE-RVs than after PTCs (16.6% vs 26.4%; p = 0.037). Conclusion: Beside a high technical efficacy of PTE-RVs, significantly fewer complications occur following PTE-RVs than following PTCs; thus, PTE-RV should be preferred over PTC alone in selected patients.