Name of the Procedure:

Placement of access through the biliary tree and into the small bowel to assist with an endoscopic biliary procedure (rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy)

Summary

This procedure involves creating a pathway through the bile ducts into the small intestine using percutaneous techniques and imaging guidance. It is often performed to facilitate another endoscopic procedure aimed at treating bile duct issues.

Purpose

The procedure addresses blockages or abnormalities in the bile ducts. The main goal is to create an access route to the bile ducts to support further endoscopic treatment, ensuring proper bile flow and relieving symptoms related to bile duct obstruction.

Indications

• Symptoms of bile duct obstruction, such as jaundice, abdominal pain, or infection.
• Preparation for a more complex endoscopic biliary intervention.
• Need for diagnostic cholangiography to visualize the biliary tree.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, might be necessary.
• Pre-procedural imaging studies, such as an ultrasound or MRCP, to assess the biliary anatomy.

Procedure Description

1. Patient is positioned appropriately and given sedation or general anesthesia, depending on the case.
2. Using ultrasound and/or fluoroscopic guidance, a needle is inserted percutaneously into the bile duct.
3. A guidewire is passed through the needle into the bile duct and further into the small bowel.
4. Once proper placement is confirmed, an access sheath may be placed to facilitate the endoscopic rendezvous procedure.
5. Diagnostic cholangiography may be performed to visualize the bile ducts.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital setting, usually in an interventional radiology or operating room.

Personnel

• Interventional Radiologist or Gastroenterologist
• Nurses
• Radiologic Technologist
• Anesthesiologist, if general anesthesia is used

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (e.g., liver, intestine)
• Bile leakage
• Rarely, pancreatitis

Benefits

• Relieves symptoms caused by bile duct obstruction.
• Allows for further necessary endoscopic treatment.
• Diagnostic cholangiography provides detailed bile duct imaging.

Recovery

• Patients will be monitored in a recovery area post-procedure.
• Pain management as needed.
• Instructions on diet and activity levels will be given.
• Follow-up appointments to monitor progress and address any concerns.

Alternatives

• Endoscopic Retrograde Cholangiopancreatography (ERCP) alone
• Surgical options for bile duct obstruction
• Non-invasive imaging and monitoring without immediate intervention

Patient Experience

• During the procedure: Sedation or anesthesia ensures comfort.
• Post-procedure: Some pain or discomfort at the insertion site.
• Pain management will be provided, with instructions on how to care for the access site.
• Gradual return to normal activities over several days.