title: Over-the-catheter precut to gain access to the biliary duct during ERCP rendezvous.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) rendezvous during laparoscopic cholecystectomy is an efficient and safe method to treat cholecystocholedocholithiasis. Advancing a guidewire through the cystic duct into the duodenum and withdrawing it in the accessory channel of duodenoscope may be, however, laborious. Moreover, rendezvous performed in the typical manner needs the use of several costly accessories. We herein describe a simpler and cheaper method to gain access to the biliary duct at rendezvous.
  
  
  METHODS
  Twenty-four consecutive patients undergoing ERCP rendezvous during laparoscopic cholecystectomy were considered. A catheter was introduced in the cystic duct and advanced into the duodenum. Access to the bile duct was than achieved by means of a precut sphincterotomy performed over the catheter emerging from the papilla.
  
  
  RESULTS
  Cannulation was successful in all but two patients, in whom ERCP was performed in the conventional manner. The only complication was a case of mild post-sphincterotomy bleeding. In comparison with the typical rendezvous technique our procedure allowed savings of about <euro>250, since its performance only requires a catheter and a knife sphincterotome.
  
  
  CONCLUSIONS
  Over-the-catheter precut during ERCP rendezvous is a feasible and safe method which avoids the need for the manipulation of several accessories and guidewires, and thus results in money and time savings.
authors.affiliation: Department of Gastroenterology, L. Sacco University Hospital, Via G. B. Grassi 74, 20157 Milano, Italy. gimanes@tin.it
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manes
authors.forename: Cinzia
authors.initials: C
authors.lastname: Baratti
authors.forename: Sandro
authors.initials: S
authors.lastname: Ardizzone
authors.forename: Fabio
authors.initials: F
authors.lastname: Ferla
authors.forename: Jean
authors.initials: J
authors.lastname: Spiropoulos
authors.forename: Fabio
authors.initials: F
authors.lastname: Corsi
authors.forename: Diego
authors.initials: D
authors.lastname: Foschi
authors.forename: Emilio
authors.initials: E
authors.lastname: Trabucchi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Bianchi Porro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult