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Observational Study
. 2024 Dec;56(1):2416607.
doi: 10.1080/07853890.2024.2416607. Epub 2024 Oct 20.

Endoscopic ultrasound-guided biliary rendezvous after failed cannulation, and comparison between benign vs malignant biliopancreatic disorders: outcomes at a single tertiary-care centre

Joan B Gornals  1   2   3 , Albert Sumalla-Garcia  1   2   3 , Sergi Quintana  1   2   3 , Daniel Luna-Rodriguez  1   2   3 , Julio G Velasquez-Rodriguez  1   2   3 , Maria Puigcerver-Mas  1   2   3 , Julia Escuer-Turu  1   2   3 , Sandra Maisterra  1   2   3 , Mar Marin  2   3   4 , Virginia Munoa  5 , Berta Laquente  2   3   4 , Juli Busquets  2   3   6
Affiliations
Observational Study

Endoscopic ultrasound-guided biliary rendezvous after failed cannulation, and comparison between benign vs malignant biliopancreatic disorders: outcomes at a single tertiary-care centre

Joan B Gornals et al. Ann Med. 2024 Dec.

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.

Keywords: Biliopancreatic diseases; biliary rendezvous; endoscopic retrograde cholangiopancreatography; endoscopy; endosonography.

Plain language summary

Last international guidelines suggest Endoscopic Ultrasound (EUS)-guided assisted bile duct access (or biliary rendezvous) after a second failed Endoscopic Retrograde Cholangiography (ERC) in benign biliary disease, in high volume centers, but its current role in malignant disease is unclear.This study provides a larger number of EUS-guided biliary rendezvous cases than reported in previous studies, and offers new and relevant information, not available in the last clinical guidelines or systematic reviewsThe EUS-guided biliary rendezvous associates better effectiveness in benign than in malignant biliopancreatic disorders. When comparing EUS-guided rendezvous with EUS-biliary transmural drainage in malignant diseases, rendezvous has a lower success, and higher adverse events. Therefore, maybe EUS-guided rendezvous is not the best option for malignant disorders and might be reserved for benign cases.

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Conflict of 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.

Figures

Figure 1.
Figure 1.
Patient flowchart of the study. EUS-guided interventional biliary procedures performed during the study period
Figure 2.
Figure 2.
Examples of EUS-guided assisted ERC (Rendezvous guidewire type). A, Transduodenal and long-scope position: the extrahepatic bile duct is punctured from the bulb. B, Transduodenal short-scope position: the extra-hepatic bile duct is punctured from the bulb. C, Transduodenal short-scope position: the extra-hepatic bile duct is punctured from the second portion of the duodenum. D, E, EUS image during puncture of extrahepatic and intrahepatic bile duct. F, Rendezvous with the guidewire passed antegradely through the papilla.
See this image and copyright information in PMC

References

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