Albert J G, Finkelmeier F, Friedrich-Rust M, Kronenberger B, Trojan J, Zeuzem S, Sarrazin C
Z Gastroenterol. 2014 Oct;52(10):1157-63. doi: 10.1055/s-0034-1366629. Epub 2014 Oct 14.
The variety of rendezvous (RV) procedures has recently been extended by EUS- and PTCD-guided procedures as a complementary means to conventional ERCP. We have identified indication criteria and the potential of biliary PTCD-guided vs. EUS-guided RV.
Consecutive patients with bile duct obstruction who underwent RV were included. In all, ERCP alone was unable to achieve treatment success. Indication, technical success, and outcome in PTCD- vs. EUS-guided RV were retrospectively compared to identify criteria that indicate preference of RV technique. Site of obstruction, clinical scenario (stenosis with abscess vs. no abscess) and reason for previous failure of ERC were evaluated.
In 32 patients, three different indications for RV procedures were identified: First, a one-step access to assist in failed ERCP (type 1, intra-ductal RV); second, temporary drainage for prolonged treatment of complex biliary disease (type 2, intra-ductal RV), and drainage of cholangio-abscess with re-establishing bile outflow (type 3, intra-abscess RV). Indication of PTCD- vs. EUS-guided rendezvous was competitive in type 1, but exclusive in favor of PTCD in types 2 and 3. The site of biliary obstruction indicated the anatomic location of RV procedures.
This classification may help to define inclusion criteria for prospective studies on biliary RV procedures. Choice of therapeutic strategy depends on the anatomic location of the biliary obstruction and the type of the biliary lesion. PTCD-guided RV might improve outcome in cholangio-abscess.
最近，内镜超声（EUS）引导和经皮经肝胆道引流（PTCD）引导的会师（RV）操作作为传统内镜逆行胰胆管造影（ERCP）的补充手段，使RV操作的种类得到了扩展。我们已经确定了胆管PTCD引导与EUS引导RV的适应症标准及潜力。
纳入连续接受RV治疗的胆管梗阻患者。总体而言，单纯ERCP无法取得治疗成功。回顾性比较PTCD引导与EUS引导RV的适应症、技术成功率和结局，以确定表明RV技术偏好的标准。评估梗阻部位、临床情况（伴有脓肿的狭窄与无脓肿）以及先前ERCP失败的原因。
在32例患者中，确定了RV操作的三种不同适应症：第一，一步法通路以辅助失败的ERCP（类型1，导管内RV）；第二，临时引流以延长复杂胆管疾病的治疗时间（类型2，导管内RV），以及引流胆管脓肿并重建胆汁流出道（类型3，脓肿内RV）。PTCD引导与EUS引导RV的适应症在类型1中具有竞争性，但在类型2和3中则排他性地有利于PTCD。胆管梗阻部位表明了RV操作的解剖位置。
这种分类可能有助于为胆管RV操作的前瞻性研究确定纳入标准。治疗策略的选择取决于胆管梗阻的解剖位置和胆管病变的类型。PTCD引导的RV可能会改善胆管脓肿的结局。
