One-stage rendezvous cleared difficult duct stones in 95% of patients

Design

Prospective single-centre cohort (registered NCT07008170)

Population

80 adults with cholecystocholedocholithiasis stratified by CT for anticipated difficult cannulation, Egypt

Primary outcome

Technical success of laparoendoscopic rendezvous

Effect

Technical success 92.5% (84.6–97.2); duct clearance 95.0%; mild pancreatitis 3.8%; no 30-day deaths

Laparoendoscopic rendezvous passes a guidewire down the cystic duct and across the papilla during laparoscopic cholecystectomy, so the endoscopist can complete sphincterotomy and stone extraction under the same anaesthetic without blind cannulation. This prospective single-centre cohort from Egypt enrolled 80 consecutive adults with gallbladder and common bile duct stones, all assessed beforehand by contrast CT for features predicting difficult cannulation.

Technical success was 92.5% (74/80, 95% CI 84.6 to 97.2) and complete duct clearance during the admission 95.0%. Post-ERCP pancreatitis occurred in 3.8%, all mild; bleeding and bile leak in 2.5% each; cholangitis in 3.8%; one perforation; no deaths at 30 days. Success fell with the number of CT risk features; a worrisome periampullary diverticulum (score 2; OR 9.4, 1.7 to 52.8) and a choledochoduodenal angle of 20° or less (OR 6.8, 1.3 to 35.4) independently predicted failure.

This is attractive where MRCP is not always available and ERCP lists are separate from theatre, which describes many Indian centres: one admission, one anaesthetic, and a low rate of mild pancreatitis in this series. It needs an endoscopist in theatre at the time of cholecystectomy, which is the real constraint. There was no comparison arm, so it does not show rendezvous is better than sequential ERCP then surgery.

• Consider rendezvous for concomitant gallbladder and duct stones when an endoscopist can attend the cholecystectomy.
• Look for a large periampullary diverticulum and a narrow choledochoduodenal angle on any CT already done; both predicted failure.
• Use those CT features in consent and theatre planning, including a fallback plan for failed wire passage.
• Expect mild post-procedure pancreatitis in a few percent; check amylase or lipase if pain is out of proportion.
• Do not order a CT solely to stratify; the study used CT because MRCP was not universally available.

Why it matters

It turns two admissions and two anaesthetics into one for patients whose papilla is likely hard to cannulate.

Don't overread it

This was a single-centre cohort of 80 without a comparison group; it does not show rendezvous outperforms sequential ERCP and cholecystectomy.

The statistics, in plain English

The odds ratios of 9.4 and 6.8 have very wide intervals (1.7 to 52.8; 1.3 to 35.4) because only six procedures failed. The direction is informative; the size is not reliable.

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