Atlas of Gastroenterological Endoscopy
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Rendezvous Manoeuvre
Tumor stenosis Dislocated PTCD-catheter
Extensive biliary duct carcinoma with jaandice and distant metastases. The filiforme stenosis canīt be passed by a guide wire during ERCP. Thus a percutaneous transhepatic choledochal drainage (PTCD) is performed. The cholangiogram (left) shows a sudden interruption of the distal biliary duct by the tumor. Several days later the transcutaneous catheter gets dislocated (right). It is decided to perform a second PTC in order to attempt stenting by means of a rendez vous manoeuvre.
Percutaneous guide wire Percutaneous guide wire in papilla
The guide wire is advanced transcutaneously through the stenosis and the papilla (left) to the duodenum. A second examiner (Rendez vous) extracts the guide wire orally using a snare (right).
Dilatator balloon Wallstent incompletely deployed
Thereafter a normal guide wire directed sphincterotomy and a ballon dilatation is performed (left x-ray). Finally a wall stent is implanted (right picture). The wall stent is not yet expanded at the site of tumor stenosis.
Bringing the dilatator balloon into position Dilatation  of a Wallstent
The stenosis is dilated carefully a second time, faciletating sufficient bile flow thereafter.
Wallstent in papilla The metall stent is in an ideal location and protrudes about 1 cm into the duodenal lumen.