Combined Approaches to Endoscopic Retrograde Biliary Access After Failed Transpapillary Approach

The term “combined procedure,” sometimes also referred to as “rendezvous procedure,” refers to a variety of techniques employing passage of a guidewire, catheter, or stent into and beyond a duct or cavity to facilitate entry to the same lumen via another route. The various antegrade routes for performance of biliary rendezvous procedures to enable retrograde access from below include: percutaneous transhepatic access by radiographic guidance, trans-cystic duct access during laparoscopic cholecystectomy, and transduodenal or transgastric access during endoscopic ultrasonography (EUS). Pancreatic rendezvous procedures are primarily EUS guided via the stomach. Traditional rendezvous procedures are successful 80-100% of the time. This article reviews the indications, techniques, and outcomes of combined procedures, with emphasis on the traditional biliary version following percutaneous transhepatic access.