Effectiveness and Safety of EUS Rendezvous After Failed Biliary Cannulation With ERCP: A Systematic Review and...

Area of Science:

• Gastroenterology and Endoscopy
• Interventional Endoscopy
• Biliary Interventions

Background:

• Conventional endoscopic retrograde cholangiopancreatography (ERCP) frequently fails in biliary cannulation for specific patient groups.
• Endoscopic ultrasound-guided rendezvous (EUS-RV) ERCP presents an alternative approach for these challenging cases.
• Existing data on EUS-RV ERCP success and adverse event rates show considerable variability.

Approach:

• A systematic review and proportion meta-analysis were conducted to evaluate EUS-RV-assisted ERCP.
• Studies reporting EUS-RV-assisted ERCP after failed conventional ERCP were identified through comprehensive database and conference proceedings searches (up to August 2020).
• Pooled rates for technical success, clinical success, and adverse events were calculated using a random-effects model.

Key Points:

• The meta-analysis included 12 studies with 342 patients.
• Pooled technical success rate for EUS-RV-assisted ERCP was 86.1% (95% CI: 78.4-91.3).
• Pooled clinical success rate was 80.8% (95% CI: 64.1-90.8), and the overall adverse event rate was 14% (95% CI: 10.5-18.4).

Conclusions:

• EUS-RV-assisted ERCP demonstrates significant effectiveness and a favorable safety profile in patients with failed conventional ERCP biliary cannulation.
• The procedure's success rates support its use as an alternative approach.
• Due to the potential for adverse events, EUS-RV-assisted ERCP should be performed in specialized centers with expertise in therapeutic endoscopic ultrasound.