Endoscopic salvage therapy after failed biliary cannulation using advanced techniques: A concise review

Figure 1 Interval endoscopic retrograde cholangiopancreatography, 1 d after the initial procedure. A: The original papilla in the initial endoscopic retrograde cholangiopancreatography (ERCP); B: Post-precut papilla, at the end of initial ERCP; C: post-precut papilla, at the beginning of interval ERCP. The papilla is swollen, edematous, and with mild oozing; D: Deep bile duct cannulation is unsuccessful during the interval ERCP, even after the placement of a pancreatic stent.

Figure 2 Interval endoscopic retrograde cholangiopancreatography, 3 d after the initial procedure. A: The original papilla in the initial endoscopic retrograde cholangiopancreatography (ERCP); B: Post-precut papilla, at the end of initial ERCP; C: post-precut papilla, at the beginning of interval ERCP. Papillary edema due to pre-cut has disappeared; D: Deep bile duct cannulation is successful during the interval ERCP.

Figure 3 Percutaneous-transhepatic-endoscopic rendezvous procedures. A: Placement of an angiocatheter to protect the liver capsule and parenchyma from guidewire damage; B: A metal stent is passed through the distal biliary stricture over the antegrade-introduced guidewire; C: Cannulation alongside the antegrade-introduced angiocatheter.

Figure 4 Endoscopic ultrasound-assisted rendezvous procedures. A: Under endoscopic ultrasound, the proximal extrahepatic bile duct is punctured through the duodenal bulb. The sonoendoscope is in a long position; B: The guidewire is delivered antegradely to the duodenum through the puncture route; C: Switch to a duodenoscope to grasp the antegradely introduced guidewire.

Figure 5 The proposed treatment algorithm. ERCP: Endoscopic retrograde cholangiopancreatography; PTBD: Percutaneous transhepatic biliary drainage; PTE-RV: Percutaneous-transhepatic-endoscopic rendezvous procedure; EUS-BD: Endoscopic ultrasound-assisted or guided biliary drainage.