The rendezvous technique has been a traditional salvage technique when transpapillary
cannulation is difficult [1]
[2]. For the rendezvous technique, a guidewire is inserted via a percutaneously or an
endosonographically created route (endoscopic submucosal resection [ESR]) into the
duodenum through the papilla and then caught under duodenoscopy to ensure transpapillary
access from the duodenum. After successfully approaching the duct from the duodenum
along the guidewire, the wire must be exchanged or inverted to use the seeking tip
to seek upward ducts.
A new double soft-tipped guidewire that has two soft angulated tips with hydrophilic
coating on both sides has been recently developed (RevoWave DualMaster; Piolax Medical
Devices, Inc., Yokohama, Japan) ([Fig. 1]). Using this guidewire, the cumbersome procedures of inverting the tips or other
alternative maneuvers are unnecessary ([Fig. 2]).
Fig. 1 Double soft tips of the RevoWave DualMaster guidewire. One tip has a long, deep angulation,
and the other has a short, light angulation. Both ends have a hydrophilic coating.
Fig. 2 The endoscopic ultrasound (EUS)-assisted rendezvous technique. a After puncturing the bile duct using EUS, a guidewire is inserted into the duodenum
through the papilla. b After the needle is withdrawn, the hard tip, which is unsuitable for seeking, is at
the oral end in the case of conventional guidewires. In the case of the DualMaster,
the first soft tip is located in the duodenum with the second soft tip outside the
body. c The echoendoscope is withdrawn so that only the guidewire and a duodenoscope are inserted
into the duodenum. The soft tip in the duodenum is caught and pulled using forceps
through the working channel. d When the caught tip is sufficiently pulled, the other tip moves into the bile duct
through the endosonographically created route. For conventional guidewires, the guidewire
must be exchanged or inverted using a catheter because the hard tip cannot be used
to negotiate upstream ducts. However, when a DualMaster is employed, negotiation and
subsequent procedures can be performed without such guidewire maneuvers because the
tip within the bile duct is suitable for seeking.
For an 85-year-old patient with biliary stones, the rendezvous technique was used
after biliary cannulation failed owing to the papilla opening within a huge diverticulum.
A DualMaster guidewire was inserted into the distal bile duct via the endosonographic
route created using a 19-gauge needle ([Video 1]). The guidewire tip, which appeared in the duodenal diverticulum through the papilla
via the distal bile duct, was caught using forceps and pulled back from the working
channel of the duodenoscope. After a cannula was inserted along the guidewire into
the distal bile duct, the wire was pulled until the other tip disengaged from the
ESR so that the tip was completely located within the bile duct. Then, the tip was
advanced toward the upward bile duct to be utilized for the subsequent sphincterotomy
and stone removal.
Video 1 Rendezvous technique facilitated by the double-forefront guidewire.
Modification of the rendezvous technique using this guidewire renders guidewire exchange
unnecessary, resulting in shorter procedure times and increased safety. It is a reasonable
option for the rendezvous technique because the procedures are simplified.
Endoscopy_UCTN_Code_TTT_1AS_2AD
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