New modification of deep biliary cannulation using endoscopic–radiologic rendezvous technique for palliative treatment of malignant obstructive jaundice

AimTo describe a new simple modification of deep biliary cannulation using combined endoscopic–radiologic technique and evaluate its technical and clinical success for palliative treatment of malignant obstructive jaundice.Patients and interventionWe used this technique in 25 patients with inoperable malignant biliary obstruction and failed endoscopy procedures alone. Using angiographic methods, an introducer of long arterial sheath, over a guide wire was passed to overcome the site of obstruction. Our amendments lie in using a stiff introducer to allow support of the guide wire during its navigation through the obstruction site, followed by passage of the introducer together with the guide wire to the duodenum, while the introducer in place; the hydrophilic guide wire with its slippery end should be replaced with a long ordinary guide wire which is used in ERCP because it could be easily grasped with the dormia basket.ResultsTechnical success rates were 100%, internal biliary stents were successfully placed in a one-step procedure at the appropriate position in all patients with adequate duct drainage. Clinical success rates were 92% within 48–72 h and 8% within 7 days. Minor complications occurred in 4/25 (16%) patients, with no reported major complication. The median procedure time was 40 min.ConclusionThis simple modification was technically and clinically successful for palliative treatment of inoperable malignant biliary obstruction with failed endoscopy procedures alone.