title: A modified Rendezvous ERCP technique in duodenal diverticulum.
abstract: OBJECTIVE
  To postoperative endoscopic retrograde cholangiopancreatography (ERCP) failure, we describe a modified Rendezvous technique for an ERCP in patients operated on for common bile duct stone (CBDS) having a T-tube with retained CBDSs.
  
  
  METHODS
  Five cases operated on for CBDSs and having retained stones with a T-tube were referred from other hospitals located in or around Istanbul city to the ERCP unit at the Haydarpasa Numune Education and Research Hospital. Under sedation anesthesia, a sterile guide-wire was inserted via the T-tube into the common bile duct (CBD) then to the papilla. A guide-wire was held by a loop snare and removed through the mouth. The guide-wire was inserted into the sphincterotome via the duodenoscope from the tip to the handle. The duodenoscope was inserted down to the duodenum with a sphincterotome and a guide-wire in the working channel. With the guidance of a guide-wire, the ERCP and sphincterotomy were successfully performed, the guide-wire was removed from the T-tube, the stones were removed and the CBD was reexamined for retained stones by contrast.
  
  
  RESULTS
  An ERCP can be used either preoperatively or postoperatively. Although the success rate in an isolated ERCP treatment ranges from up to 87%-97%, 5%-10% of the patients require two or more ERCP treatments. If a secondary ERCP fails, the clinicians must be ready for a laparoscopic or open exploration. A duodenal diverticulum is one of the most common failures in an ERCP, especially in patients with an intradiverticular papilla. For this small group of patients, an antegrade cannulation via a T-tube can improve the success rate up to nearly 100%.
  
  
  CONCLUSIONS
  The modified Rendezvous technique is a very easy method and increases the success of postoperative ERCP, especially in patients with large duodenal diverticula and with intradiverticular papilla.
authors.affiliation: Mehmet Odabasi, Mehmet Kamil Yildiz, Haci Hasan Abuoglu, Cengiz Eris, Erkan Ozkan, Emre Gunay, Ali Aktekin, MA Tolga Muftuoglu, Department of Surgery, Haydarpasa Education and Research Hospital, Istanbul, 34688, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Odabasi
authors.forename: Mehmet Kamil
authors.initials: MK
authors.lastname: Yildiz
authors.forename: Haci Hasan
authors.initials: HH
authors.lastname: Abuoglu
authors.forename: Cengiz
authors.initials: C
authors.lastname: Eris
authors.forename: Erkan
authors.initials: E
authors.lastname: Ozkan
authors.forename: Emre
authors.initials: E
authors.lastname: Gunay
authors.forename: Ali
authors.initials: A
authors.lastname: Aktekin
authors.forename: Ma Tolga
authors.initials: MT
authors.lastname: Muftuoglu
keywords: Antegrade cannulation; Endoscopic retrograde cholangiopancreatography; Intradiverticular papilla; Retained stones; T-tube