Endoscopic ultrasound-guided gallbladder drainage to facilitate biliary rendezvous for the management of cholangitis due to choledocholithiasis.

An 81-year-old man presented with upper abdominal pain, nausea, and vomiting, with elevated liver test results. Abdominal computed tomography demonstrated mild intraand extrahepatic biliary ductal dilation (common bile duct 11mm), with choledocholithiasis, layering gallstones, and enhancement and thickening of the gallbladder wall. Endoscopic retrograde cholangiopancreatography (ERCP) was attempted, but biliary cannulation of an intradiverticular papilla failed, despite precut sphincterotomy. Endoscopic ultrasonography (EUS)-guided gallbladder drainage provided initial biliary decompression. Subsequently, biliary rendezvous via the gallbladder conduit facilitated conventional ERCP with sphincterotomy and stone extraction, as described below (▶Video1). After failed ERCP and during the same endoscopic session, an oblique-viewing, linear-array echoendoscope (Olympus, Tokyo, Japan) was passed in anticipation of biliary rendezvous. A decision was made to perform biliary decompression via the distended gallbladder, to address underlying cholecystitis in this poor operative candidate. Cholecystoduodenostomy (▶Fig. 1) was performed using a 19 G needle (Expect; Boston Scientific, Marlborough, Massachusetts, USA) for access, aspiration, and contrast injection. A 0.025 inch guidewire, 450 cm in length (VisiGlide; Olympus America, Center Valley, Pennsylvania, USA) was coiled E-Videos