title: Rendezvous technique versus endoscopic retrograde cholangiopancreatography to treat bile duct stones reduces endoscopic time and pancreatic damage.
abstract: BACKGROUND
  Endoscopic procedures on Vater's papilla are related to pancreatic damage with or without pathologic increase of pancreatic enzymes. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy is a standard treatment for common bile duct stones, performed sequentially before or after laparoscopic cholecystectomy. The "rendezvous" (RV) procedure combines laparoscopic cholecystectomy, intra-operative cholangiography, and endoscopic bile duct clearance and is an alternative to the sequential treatment. We tried to analyze relevant differences between the two options concerning the main parameters of pancreatic damage.
  
  
  METHODS
  Thirty-eight patients treated for biliary stones were divided into two groups of 19 patients depending on the type of treatment (RV vs. ERCP) and were compared for post-procedural amylase and lipase levels; the duration of the endoscopic procedures, effectiveness, and complications were also recorded.
  
  
  RESULTS
  A pathologic increase of serum amylase occurred in 15.7% of the RV group and 47.3% of the ERCP group with significant differences regarding amylase levels in the 6- and 66-hour samples (p < 0.003; p < 0.006). The mean duration of endoscopic procedure was significantly shorter in the RV group (17 vs. 26 minutes, p < 0.0001). RV was effective in common bile duct clearance in 100% of cases, while ERCP was effective in only 89.5%. Minor morbidity affected one patient in each group.
  
  
  CONCLUSIONS
  This is the first report comparing combined laparoendoscopic RV versus ERCP for potential pancreatic damage and showing that RV reduces the number of patients with an iatrogenic pathologic increase of amylase when compared to ERCP, and also significantly reduces the duration of endoscopic procedure.
authors.affiliation: Department of Surgical Sciences, Transplantation, and Advanced Technologies, Cannizzaro Hospital, University of Catania, Catania, Italy. glagreca@unict.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Greca
authors.forename: Francesco
authors.initials: F
authors.lastname: Barbagallo
authors.forename: Michele
authors.initials: M
authors.lastname: Di Blasi
authors.forename: Manuela
authors.initials: M
authors.lastname: Di Stefano
authors.forename: Giorgio
authors.initials: G
authors.lastname: Castello
authors.forename: Salvina
authors.initials: S
authors.lastname: Gagliardo
authors.forename: Saverio
authors.initials: S
authors.lastname: Latteri
authors.forename: Domenico
authors.initials: D
authors.lastname: Russello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002758:Cholangiography / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000097:blood / Q000209:etiology; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D013997:Time Factors
chemical_list: D008049:Lipase; D000681:Amylases