Parallel cannulation technique at ERCP rendezvous.

BACKGROUND: Biliary access at ERCP rendezvous is usually achieved by withdrawing a wire passed antegrade via the accessory channel of the duodenoscope, which is then used for over-the-wire cannulation. The wire is time consuming to maneuver and may be damaged during withdrawal.
OBJECTIVE: Description of a simple technique for cannulation at rendezvous that overcomes these problems.
DESIGN: Observational study.
SETTING: Gastroenterology department of a teaching district general hospital. PATIENTS: Fourteen consecutive patients undergoing rendezvous after percutaneous transhepatic cholangiography (PTC). INTERVENTION: A transpapillary drain was placed at PTC in 13 patients. At rendezvous, cannulation alongside the drain was attempted with a sphincterotome cannula. After successful cannulation, the drain was progressively withdrawn, allowing retrograde therapeutic intervention.
RESULTS: In all 13 patients, parallel cannulation was successful, allowing stone removal or biliary stent placement, with cannulation alongside a guidewire in the fourteenth patient. There were no complications except right hypochondrial pain after drain removal.
CONCLUSIONS: Parallel cannulation is straightforward and effective, avoiding the need for guidewire manipulation.