Endoscopic ultrasound-guided rendezvous for biliary access after failed cannulation

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Selective biliary cannulation failure occurs in ~3% of endoscopic retrograde cholangiography (ERC) procedures.
• Endoscopic ultrasound-guided rendezvous (EUS-RV) offers a potential salvage strategy for these challenging cases.
• The safety and efficacy of EUS-RV as a primary salvage technique require further evaluation.

Purpose of the Study:

• To determine the safety and efficacy of the endoscopic ultrasound-guided rendezvous (EUS-RV) technique.
• To evaluate EUS-RV as a primary salvage method following failed selective biliary cannulation.
• To assess the success rate and complications associated with EUS-RV.

Main Methods:

• Forty patients with failed selective biliary cannulation underwent salvage EUS-RV.
• EUS-guided puncture of the biliary duct (intra- or extra-hepatic) was performed from the stomach or small intestine.
• Antegrade guidewire manipulation into the small intestine followed by guidewire-assisted biliary cannulation was attempted.

Main Results:

• Successful antegrade guidewire manipulation into the small intestine was achieved in 73% of patients (29/40).
• Reasons for failure included inability to advance the guidewire through obstructions or the native ampulla.
• Complications occurred in 13% of patients, with no clear relation to the EUS-RV procedure itself.

Conclusions:

• EUS-RV is a safe and effective primary salvage technique for failed biliary cannulation.
• Immediate re-attempt at ERC after failed EUS-RV can be successful in some cases.
• Prompt availability of alternative biliary drainage methods is crucial.