A Proposed Algorithm for Endoscopic Ultrasound-Guided Rendezvous Technique in Failed Biliary Cannulation

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Selecting an approach route for endoscopic ultrasound-guided rendezvous (EUS-RV) in failed biliary cannulation is challenging.
• A structured algorithm for EUS-RV route selection was developed to address this complexity.

Purpose of the Study:

• To evaluate the efficacy and safety of a proposed algorithm for selecting approach routes in EUS-RV procedures.
• To determine the optimal sequence of routes for successful biliary cannulation via EUS-RV.

Main Methods:

• Retrospective analysis of 16 consecutive EUS-RV cases from April 2017 to July 2020.
• The algorithm prioritized routes: distal extrahepatic bile duct (DEHBD/D2), proximal extrahepatic bile duct (PEHBD/D1), left intrahepatic bile duct (LIHBD/S), and right intrahepatic bile duct (RIHBD/D1).
• Data collected included route used, success rate, time to guidewire placement, and adverse events.

Main Results:

• The DEHBD/D2 route was the most frequently used (62.5%).
• Successful biliary cannulation was achieved in all 16 patients.
• The DEHBD/D2 route demonstrated a significantly shorter time to guidewire placement (3.5 min) compared to other routes (14.0 min; p=0.014).
• One patient experienced moderate pancreatitis.

Conclusions:

• The proposed algorithm appears effective for guiding the selection of appropriate approach routes in EUS-RV.
• This systematic approach may improve procedural efficiency and success rates in complex biliary cannulation cases.