Skip to main content
SpringerLink
Log in

Use of the laparoscopic–endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasis

A valid method in cases with patient-related risk factors for post-ERCP pancreatitis

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Several studies have shown the efficacy and effectiveness of the combined endoscopic–laparoscopic “rendezvous” technique for treatment of gallbladder and bile duct stones without complications, particularly pancreatitis. The so-called rendezvous technique consists of laparoscopic cholecystectomy standards with intraoperative cholangiography followed by endoscopic sphincterotomy (EST). The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. This method allows easier and faster cannulation, thus avoiding papillary edema and pancreatic trauma. The aim of this study was to evaluate whether this method is effective in eliminating ductal stones and to verify whether the risk of postprocedure pancreatitis is diminished.

Methods

From January 2002 to September 2004, we enrolled 256 patients with cholecystocholedolithiasis detected by transabdominal ultrasound and magnetic resonance cholangiopancreatography. One hundred and twenty of these had one or more patient-related risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, so they were randomized into two groups of 60 patients. In group A, the patients were treated in a single step with videolaparoscopic cholecystectomy, intraoperative cholangiography, and EST during the surgical procedure with the rendezvous technique. In group B, preoperative ERCP and EST were performed by using a traditional method of bile duct cannulation.

Results

No cases of post-ERCP pancreatitis were observed in group A, whereas six cases of acute post-ERCP pancreatitis occurred in group B (five mild and one moderate) (p = 0.0274). No procedure-related mortality was recorded.

Conclusion

In cholecysthocholedocholithiasis, the combined laparoscopic–endoscopic approach prevents post-ERCP pancreatitis in cases with patient-related risk factors for this complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Andriulli A, Leandro G, Niro G, Mangia A, Festa V, Gambassi G, et al. (2000) Pharmacologic treatment can prevent pancreatic injury after ERCP: a meta-analysis. Gastrointest Endosc 51: 1–7

    Article  CAS  PubMed  Google Scholar 

  2. Arcidiacono R, Gambitta P, Rossi A, Grosso C, Bini M, Zanasi G (1994) The use of a long-acting somatostatin analogue (Octreotide) for prophylaxis of acute pancreatitis after endoscopic sphincterotomy. Endoscopy 26: 715–718

    CAS  PubMed  Google Scholar 

  3. Baillie J, Paulson EK, Vitellas KM (2003) Biliary imaging: a review. Gastroenterology 124: 1686–1699

    Article  PubMed  Google Scholar 

  4. Carr-Locke DL (2002) Therapeutic role of ERCP in the management of suspected common bile duct stones. Gastrointest Endosc 56: 170–174

    Google Scholar 

  5. Cavallini G, Tittobello A, Frulloni L, Masci E, Mariani A, Di Francesco V, et al. (1996) Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography. N Engl J Med 335: 919–923

    Article  CAS  PubMed  Google Scholar 

  6. Davis WZ, Cotton PB, Arias RS, Williams DM, Onken JE (1997) ERCP and sphincterotomy in the context of laparoscopic cholecystectomy; academic and community practice patterns and results. Am J Gastroenterol 92: 597–601

    CAS  PubMed  Google Scholar 

  7. European Association for Endoscopic Surgery Committee (1998) Diagnosis and treatment of common bile duct stones (CBDS). Surg Endosc 12: 856–864

    Google Scholar 

  8. Fanti L, Agostoni M, Casati A, Guslandi M, Giollo P, et al. (2004) Target-controlled propofol infusion during monitored anaesthesia in patients undergoing ERCP. Gastrointest Endosc 60: 361–366

    Article  PubMed  Google Scholar 

  9. Frazee RC, Robert J, Symmonds R, Hendricks JC, Snyder S, et al (1993) Combined laparoscopic and endoscopic management of cholelithiasis and choledocholithiasis. 166: 702–705

  10. Freeman ML, DiSario JA, Nelson DB, Fennerty B, Lee JG, Bjorkman DJ, et al. (2001) Risk factors for post ERCP pancreatitis: a prospective multicenter study. Gastrointest Endosc 54: 425–434

    CAS  PubMed  Google Scholar 

  11. Freeman ML, Guda N (2004) Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc 59: 845–864

    PubMed  Google Scholar 

  12. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335: 909–918

    Article  CAS  PubMed  Google Scholar 

  13. Gottlieb K, Sherman S, Pezzi J, Esber E, Lehman GA (1996) Early recognition of post-ERCP pancreatitis by clinical assessment and serum pancreatic enzymes. Am J Gastroenterol 91: 1553–1557

    CAS  PubMed  Google Scholar 

  14. Huntigton TR, Bohlman TW (1997) Laparoscopic biliary guidewire: a simplified approach to choledocholithiasis. Gastrointest Endosc 45: 295–297

    Google Scholar 

  15. Iodice G, Giardello C, Francica G, Sarrantonio G, Angelone G, Cristiano S, et al. (2001) Single-step treatment of gallbladder and bile duct stones: a combined endoscopic–laparoscopic technique. Gastrointest Endosc 53: 336–338

    CAS  PubMed  Google Scholar 

  16. Ko CW, Lee SP (2002) Epidemiology and natural history of common bile duct stones and prediction of disease. The NIH State-of-the Science Conference: ERCP for diagnosis and therapy. Gastrointest Endosc 56(Suppl): 165–169

    Google Scholar 

  17. Lella F, Bagnolo F, Colombo E, Bonassi U (2004) A simple way of avoiding post-ERCP pancreatitis. Gastrointest Endosc 59: 830–834

    Article  PubMed  Google Scholar 

  18. Long WB, Shwarz W, Ring EJ (1984) Endoscopic sphincterotomy assisted by catheterization antegrade. Gastrointest Endosc 30: 36–39

    CAS  PubMed  Google Scholar 

  19. Loperfido S, Angelini GP, Benedetti G, Chilovi F, Costan F, De Berardinis F, et al. (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48: 1–10

    Article  CAS  PubMed  Google Scholar 

  20. Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, et al. (2001) Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 96: 417–423

    Article  CAS  PubMed  Google Scholar 

  21. Pasha TM, Therneau T, Petersen BT (1997) Economic analysis of gabexate mesilate in post-ERCP pancreatitis [Abstract]. Gastroenterology 112: A471

    Article  Google Scholar 

  22. Petelin JB (2002) Surgical management of common bile duct stones. Gastrointest Endosc 56(Suppl): 183–189

    Google Scholar 

  23. Shorvon PJ, Cotton PB, Mason RR (1985) Percutaneous transhepatic assistance for duodenal sphincterotomy. Gut 26: 1373–1376

    CAS  PubMed  Google Scholar 

  24. Singh P, Das A, Isemberg G, Wong RCK, Sivak MV, Agrawal D, Chak A (2004) Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trial. Gastrointest Endosc 60: 544–550

    PubMed  Google Scholar 

  25. Testoni PA, Bagnolo F (2001) Pain at 24 hours associated with amylase levels 5 times greater than the upper normal limit as the most reliable indicator of post-ERCP pancreatitis. Gastrointest Endosc 53: 33–39

    Article  CAS  PubMed  Google Scholar 

  26. Testoni PA, Bagnolo F, Caporuscio S, Lella F (1999) Serum amylase measured four hours after endoscopic sphincterotomy is a reliable predictor of postprocedure pancreatitis. Am J Gastroenterol 94: 1235–1241

    CAS  PubMed  Google Scholar 

  27. Testoni PA, Caporuscio S, Bagnolo F, Lella F (1999) Twenty-four hour amylase predicting pancreatic reaction after endoscopic sphincterotomy. Endoscopy 31: 131–136

    Article  CAS  PubMed  Google Scholar 

  28. Testoni PA, Lella F, Bagnolo F, Caporuscio S, Cattani L, Colombo E, et al. (1996) Long-term prophylactic administration of octreotide reduces the rise in serum amylase after endoscopic procedures on Vater’s papilla. Pancreas 13: 61–65

    CAS  PubMed  Google Scholar 

  29. Tham TCK, Carr-Locke DL (1999) Endoscopic treatment of bile duct stones in elderly people. Br Med J 318: 617–618

    CAS  Google Scholar 

  30. Tham TC, Vandrvoort J, Wong RC, Carr-Locke DL (1996) Endoscopic sphincterotomy with gallbladder left in situ versus open surgery for common bile duct calculi. Lancet 348: 264

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Policlinico San Marco, Corso Europa 7, Zingonia, BG, 24040, Italy

    F. Lella, F. Bagnolo, U. Bonassi & E. Colombo

  2. Department of Surgery, Policlinico San Marco, Corso Europa 7, Zingonia, BG, 24040, Italy

    C. Rebuffat & M. Scalambra

Authors
  1. F. Lella
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Bagnolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Rebuffat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Scalambra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Bonassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Colombo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Lella.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lella, F., Bagnolo, F., Rebuffat, C. et al. Use of the laparoscopic–endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasis. Surg Endosc 20, 419–423 (2006). https://doi.org/10.1007/s00464-005-0356-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0356-6

Keywords

Search

Navigation