ABSTRACT

Background Endoscopic ultrasound (EUS)-guided biliary rendezvous (RV) is an EUS-assisted technique described as a rescue method in cases of failed biliary cannulation via endoscopic retrograde cholangiography (ERC). Current literature remains unclear regarding its current role. The study aim was to evaluate the effectiveness for biliary EUS-RV, and comparison between benign vs malignant biliopancreatic disorders.

Methods Retrospective observational study with prospective consecutive inclusion in a specific database from a tertiary-center. All patients with biliopancreatic diseases that underwent a EUS-assisted ERC between October-2010 and November-2022 for failed ERC were included. Main outcomes were technical/overall success. Secondary outcomes were safety, potential factors related to failure/success or safety; and a comparative analysis between EUS-RV and EUS-guided transmural drainage (TMD) in malignant cases.

Results A total of 69 patients who underwent EUS-RV procedures, with benign and malignant pathologies (n=40 vs n=29), were included. Technical/overall success and related-adverse events (AEs) were 79.7% (95%CI, 68.3-88.4)/74% (95%CI, 61-83.7) and 24% (95%CI, 15.1-36.5), respectively. Failed cases were mainly related with guidewire manipulation. Seven failed RV were successfully rescued by EUS-TMD. On multivariable analysis, EUS-RV and malignant pathology was associated with a greater failure rate (technical success: OR,0.21; 95%CI,0.05-0.72; p=0.017), and higher AEs rate (OR,3.46; 95%CI,1.13-11.5; p=0.034). Also, the EUS-TMD group had greater technical success (OR,16.96; 95%CI,4.69-81.62; p<0.001) and overall success (OR, 3.09; 95%CI,1.18-8-16; p<0.026) with a lower AEs rate (OR,0.30; 95%CI,0.11-0.78; p=0.014) than EUS-RV in malignant disorders.

Conclusions EUS-RV is a demanding technique with better outcomes in benign than in malignant biliopancreatic diseases. Comparison of the EUS-TMD group on malignant disorders showed worse outcomes with EUS-RV. Given these findings, maybe EUS-RV is not the best option for malignant biliopancreatic disorders.

Competing Interest Statement

JBG is a consultant for Boston Scientific and has received a Fujifilm grant. The other authors have no conflicts of interest to disclose.

Clinical Trial

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Clinical Protocols

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Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by our institutional ethics committee (ICPS015/20, Comitè Ètic d’Investigació Clínica, Hospital Universitari de Bellvitge) and conducted in accordance with the principles of the Declaration of Helsinki and the guidelines for Good Clinical Practice.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Footnotes

Conflict of interest: Dr. Gornals is a consultant for BostonSc and has received a Fujifilm grant; the other authors have no conflicts of interest to disclose.

No financial disclosures. No grant support.

All authors have read and agreed on the content of this manuscript.

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

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AcronymsAEadverse eventCBDcommon bile ductERCPendoscopic retrograde cholangiopancreatographyEUSendoscopic ultrasoundLAMSlumen apposing metal stentMBOmalignant biliary obstructionRVrendezvous