[Internal biliary drainage in the "rendezvous" procedure. Combined transhepatic endoscopic retrograde methods].

Positioning of an internal biliary drainage is the treatment of choice in inoperable malignant stenoses of the ductus hepatocholedochus. The "rendezvous procedure" combines percutaneous transhepatic and endoscopic retrograde cholangiography. It enables positioning of the internal drain in about 95% of the cases within 40-60 minutes at a low complication rate. This method has been applied so far in 22 patients and was successful in 21 cases. A steel guide protected by a plastic catheter is advanced transhepatically into the duodenum. Papillotomy which cannot be achieved by conventional technique is performed by the Mori-knife technique. The drain (French 11-12) is positioned with endoscopic viewing employing the conventional technique. Highly positioned or long stenoses can be overcome more effectively with this method. The transhepatic guide can be tautened, resulting in a markedly enhanced thrust to position a drain in patients with Billroth II gastrectomy. Conversion of percutaneous to internal biliary drainage is usually feasible.