Pre-Cut Papillotomy Versus Endoscopic Ultrasound-Rendezvous for Difficult Biliary Cannulation: A Systematic Review...

Area of Science:

• Gastroenterology
• Interventional Endoscopy

Background:

• Difficult biliary cannulation poses challenges during endoscopic retrograde cholangiopancreatography (ERCP).
• Existing endoscopic techniques carry risks including bleeding, infection, pancreatitis, and cholangitis.
• Comparing alternative methods is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the technical success rates of pre-cut papillotomy and endoscopic ultrasound (EUS)-rendezvous for difficult biliary access.
• To evaluate and compare the incidence of post-procedure pancreatitis and bleeding between these two techniques.

Main Methods:

• A systematic review and meta-analysis of comparative studies.
• Inclusion of studies comparing pre-cut papillotomy and EUS-rendezvous.
• Random-effects model used to calculate risk ratios (RRs) and confidence intervals (CIs) for primary and secondary outcomes.

Main Results:

• Four studies involving 1,004 patients with difficult biliary cannulation were analyzed.
• Technical success rates were similar between pre-cut papillotomy and EUS-rendezvous (RR: 0.95, 95% CI (0.88, 1.02)).
• No significant differences were observed in post-procedure pancreatitis (RR: 1.82, 95% CI (0.80, 4.15)) or bleeding (RR: 2.80, 95% CI (0.67, 11.66)).

Conclusions:

• Pre-cut papillotomy and EUS-rendezvous are equally effective and safe for difficult biliary cannulation.
• No significant difference in technical success or complication rates (pancreatitis, bleeding) was found.
• Further randomized controlled trials are recommended to confirm these findings.