Endoscopic ultrasound-guided rendezvous vs precut for difficult biliary cannulation: Updated meta-analysis

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Medical Imaging

Background:

• Difficult biliary cannulation (DBC) presents a significant challenge in endoscopic retrograde cholangiopancreatography (ERCP).
• Precut techniques are commonly employed as rescue strategies when standard cannulation fails.
• Endoscopic ultrasound-guided rendezvous (EUS-RV) is emerging as an alternative for biliary access.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness and safety of EUS-RV versus precut techniques for biliary access in cases of DBC.
• To compare technical success rates and adverse event (AE) rates between EUS-RV and precut techniques.

Main Methods:

• A systematic literature search was performed across PubMed, Embase, and Cochrane Library databases.
• Included studies compared EUS-RV and precut techniques in adult patients experiencing DBC.
• Data were pooled using a random-effects model to determine relative risks and confidence intervals.

Main Results:

• Five studies (2 RCTs, 3 retrospective cohorts) involving 875 patients were analyzed.
• EUS-RV demonstrated a significantly higher technical success rate (95.9%) compared to precut techniques (91.4%).
• Adverse event rates were comparable between EUS-RV (7.7%) and precut techniques (11.2%), with no statistically significant difference.

Conclusions:

• EUS-RV is associated with superior technical success rates for rescue biliary cannulation following failed ERCP, with a comparable safety profile to precut methods.
• EUS-RV represents a valuable alternative rescue strategy for DBC, particularly when endoscopic ultrasound expertise is available.
• Further research is warranted to fully assess the safety, procedural duration, and learning curve associated with EUS-RV.