EUS-guided versus PTC-guided rendezvous in case of failed ERCP: a case-control study

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) can fail to achieve biliary cannulation.
• Percutaneous transhepatic cholangiography rendezvous (PTC-RV) and endoscopic ultrasound-guided rendezvous (EUS-RV) are salvage techniques for failed ERCP.
• Comparative data between EUS-RV and PTC-RV are limited.

Purpose of the Study:

• To compare the efficacy and safety of EUS-RV versus PTC-RV.
• To evaluate these techniques in a tertiary referral center setting.
• To assess outcomes in specific biliary conditions like malignant biliary strictures, benign biliary strictures, and common bile duct stones.

Main Methods:

• A case-control study design was employed.
• Patients undergoing rendezvous procedures for failed biliary cannulation between February 2014 and March 2022 were included.
• PTC-RV cases (Feb 2014-Feb 2018) were compared to EUS-RV cases (Mar 2018-Mar 2022).

Main Results:

• A total of 59 procedures (20 PTC-RV, 39 EUS-RV) were analyzed.
• Technical success rates were 90.0% for PTC-RV and 71.8% for EUS-RV (P=0.184).
• Adverse event rates were similar: 35.0% for PTC-RV and 33.3% for EUS-RV (P=1.000), with major adverse events also comparable.

Conclusions:

• Endoscopic ultrasound-guided rendezvous (EUS-RV) offers an acceptable success rate for biliary cannulation after failed ERCP.
• EUS-RV is not associated with a significantly increased risk of adverse events compared to PTC-RV.
• Both EUS-RV and PTC-RV serve as valuable salvage techniques in managing difficult biliary access cases.