A Catheter-Guided Rendezvous Technique to Perform Endoscopic Retrograde Cholangiopancreatography in Patients With High-Risk Choledocholithiasis

Sep 30, 2026

Uploaded by Adam

A catheter-guided variation of the rendezvous technique for choledocholithiasis replaces a guidewire with a peripherally inserted central catheter (PICC). Three patients aged 47–84 years with bile duct stones underwent the approach during laparoscopic cholecystectomy at a tertiary center. Biliary cannulation and complete stone extraction were achieved in all cases without intraoperative or postoperative complications. The mean hospital stay was 3 days, and larger studies are needed to confirm efficacy, safety, and cost-effectiveness.

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

Case Report

Patient selection and diagnosis

Case 1

ACG CASE REPORTS JOURNAL CASE REPORT | BILIARY A Catheter-Guided Rendezvous Technique to Perform Endoscopic Retrograde Cholangiopancreatography in Patients With High-Risk Choledocholithiasis Daniel Azamar-Llamas, MD 1 , Fernando Quijano Orvañanos, MD2 , and Diego Angulo-Molina, MD 1 1 Endoscopy Department, Centro Me´dico ABC, Ciudad de Mexico, Mexico 2Surgery Department, Centro Medico ABC, Ciudad de Mexico, Mexico ABSTRACT We describe a variation of the rendezvous technique for choledocholithiasis using a peripherally inserted central catheter (PICC) instead of a guidewire. Three patients (aged 47–84 years) with bile duct stones underwent this approach during laparoscopiccholecystectomy at a tertiary center. Biliary cannulation and complete stone removal were successful in all cases, with no intraoperative or postoperative complications. The average hospital stay was 3 days. This technique appears feasible, although larger studies are needed to conﬁrm its efﬁcacy, safety, and potential cost-effectiveness. KEYWORDS: ERCP; rendezvous; choledocholithiasis ABBREVIATIONS: ALP, alkaline phosphatase; ALT, alanine transaminase; AST, aspartate transaminase; CBD, common bile duct; CRP, Creactive protein; ERCP, endoscopic retrograde cholangiopancreatography; GGT, gamma glutamyltransferase; LC, laparoscopic cholecystectomy; MRCP, magnetic resonance cholangiopancreatography; PICC, peripherally inserted central catheter; WBC, white blood cells INTRODUCTION The rendezvous technique has been previously used during cholecystectomy for the treatment ofcholedocholithiasisin the setting of cholecystitis, demonstrating success rates comparable to those of endoscopic retrograde cholangiopancreatography (ERCP) performed before surgery with less complications associated with the ERCP, such as canulation of the pancreatic duct and its complications, edema of the papilla, less use of precut, and less in hospital stay.1,2 This approach is particularly useful in patients with complex anatomy.3,4 Also, it has the potential of reducing costs to the patient with conﬁrmed or high risk of choledocholithiasis because the problem can be solved in only one procedure, and in theory, reducing the risks associated with anesthesia. In the conventional rendezvous technique, a metallic guidewire is advanced through the cystic duct and out the ampulla. However, in some patients, the guidewire may fail to pass, or it maybe harder to manipulate by the surgical team and pass through the cystic duct during laparoscopy because of the size of the guidewire (usually 0.025 or 0.035 inches and 230-450 cm in length) . To overcome this limitation, we developed a modiﬁed approach in which a 5 Fr peripherally inserted central catheter (PICC) is used instead. This catheter was chosen because of its size (0.065 inches in diameter and 50–60 cm in length), ﬂexibility, and ease of manipulation. The catheter is advanced through the cystic duct and ampulla with ﬂuoroscopic guidance, followed by the introduction of a duodenoscope. A sphincterotome loaded with a guidewire is then passed through the working channel, aligned with the PICC, and the guidewire is advanced into the common bile duct (CBD) . Once the guidewire is securely in place, the PICC is withdrawn, and standard ERCP is performed, with sphincterotomy and balloon sweep to remove the stones. After the ERCP is completed, the cystic duct is clipped, and the laparoscopic cholecystectomy (LC) was completed (Figure 1) . ACG Case Rep J 2026;13:e01960 . doi:10 . 14309/crj.0000000000001960. Published online: January 8, 2026 Correspondence: Diego Angulo-Molina, MD ([angulod@yahoo.com](angulod@yahoo.com)) . ACG Case Reports [Journal / Volume 13 acgcasereports.com 1](Journal / Volume 13 acgcasereports.com 1) Azamar-Llamas et al Catheter-Guided Rendezvous Technique Figure 1. In this novel technique, a 5 Fr PICC catheter is passed through the cystic duct, the common bile duct to the ampulla. There, a sphincterot

FAQs

What modification does this technique use compared with the conventional rendezvous method?

It uses a peripherally inserted central catheter (PICC) advanced through the cystic duct instead of a metallic guidewire.

How is standard ERCP performed after the catheter-guided rendezvous step?

After the guidewire is secured in the common bile duct, the PICC is withdrawn and standard ERCP follows with sphincterotomy and balloon sweep for stone removal.

What were the reported outcomes in the three treated patients?

Biliary cannulation and complete stone removal were successful in all cases, with no intraoperative or postoperative complications and an average hospital stay of 3 days.

Sep 30, 2026

Uploaded by Adam