A novel hitch-and-ride deep biliary cannulation method during rendezvous endoscopic ultrasound-guided ERCP technique

Background and study aim Endoscopic ultrasound-guided rendezvous (EUS-RV) is increasingly reported as a treatment option after failed endoscopic retrograde cholangiopancreatography. We developed a novel hitch-and-ride catheter for biliary cannulation to reduce the risk of guidewire loss during EUS-RV. Patients and methods We retrospectively evaluated safety and technical success of EUS-RV between June 2011 and May 2016.Biliary cannulation during EUS-RV using three methods-over-the-wire, along-the-wire, and hitch-and-ride-were compared. Results A total of 30 EUS-RVs were attempted and the technical success rate was 93.3%, with two failures (one bile duct puncture and one guidewire insertion). After 28 cases of successful guidewire passage, cannulation was attempted by the over-the-wire (n=13), along-the-wire (n=4) or hitch-and-ride (n=11) method. Only the hitch-and-ride method achieved biliary cannulation without guidewire loss or conversion to the other methods. Time to cannulation was shorter with the hitch-and-ride method (4 minutes) than with over-the-wire and along-the-wire methods (9 and 13 minutes, respectively). The adverse event rate of EUS-RV was 23.3%. Conclusion A novel hitch-and-ride catheter was feasible for biliary cannulation after EUS-RV.