Percutaneous Transcholecystic Approach to the Rendezvous Procedure when Transhepatic Access Fails

Extrahepatic biliary obstruction can be managed endoscopically or percutaneously. When endoscopic therapy fails, percutaneous drainage with or without endoscopic assistance may be performed. However, transhepatic drainage may itself be unsuccessful. In such patients, a transcholecystic approach combined with endoscopic therapy was used to achieve biliary drainage. After attempts at transhepatic biliary drainage failed, a percutaneous cholecystostomy was performed in four patients, with subsequent cannulation of the common bile duct, endoprosthesis insertion, or papillotomy. The success rate was 100%, with no major complication or procedure-related mortality. Slight bleeding from a sphincterotomy was the only minor complication. When percutaneous transhepatic access to the bile duct fails, the transcholecystic route can be safely used with care to successfully achieve biliary drainage.