Endoscopic Ultrasound-guided Rendezvous Technique versus Precut Sphincterotomy as Salvage Technique for Biliary Access: A Meta-Analysis

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment option for obstructive jaundice, with a 90% technical success rate, however, common bile duct cannulation can fail in up to 10% of patients. The standard salvage technique used for difficult bile duct cannulation is precut sphincterotomy, whereas endoscopic ultrasound-guided rendezvous technique (EUS-RV) is a relatively newer method. The EUS-RV technique consists of puncturing the bile duct using EUS guidance and maneuvering of the guidewire across the papilla prior to cannulation with ERCP, while precut sphincterotomy involves a deliberate incision to facilitate cannulation. Despite their use in clinical practice, the comparative effectiveness of these techniques remains unclear. This meta-analysis aims to evaluate and compare the outcomes of EUS-RV and precut sphincterotomy as salvage techniques for biliary access.

Methods Major electronic databases and grey literature sources were searched up to August 2024 for randomized controlled trials and cohorts, and RevMan 5.4 was utilized to compute. Three studies (Dhir 2012, Choudhury 2021, Ko and Su 2024) were included [1] [2] [3].

Results The success rates as salvage technique for difficult biliary cannulation between EUS-RV and precut sphincterotomy were compared. Resulting I2 of 0% (p=0.37) implies that heterogeneity does not exist. Resulting pooled odds ratio 1.71 (95% CI 0.71 to 4.11) is not significant, implying no significant difference between the two groups. The forest plot also shows that the diamond market intersects the 1 axis, suggesting that the odds ratio is not significant. It is also interesting to note that two of the three studies (Choudhury 2021 and Ko and Su 2024) stated that both techniques appeared to be complementary, with all patients with failure using one technique successfully being cannulated after crossing over to the other group.

Conclusions Both EUS-RV technique and precut sphincterotomy serve as effective salvage methods for biliary access, showing no significant difference in success rates. Hence, the choice between these two techniques can be based on individual patient needs and endoscopist expertise.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Tamma F.. et al. 'The Role of EUS-Guided Rendezvous Technique in Failed ERCP: A Comparison with Precut Sphincterotomy.'. Journal of Clinical Gastroenterology 2023; 57 (1): 12-19
• 2 Khashab M.A.. et al. 'Efficacy of Endoscopic Ultrasound-Guided Rendezvous Technique Compared to Precut Sphincterotomy for Difficult Biliary Access: A Systematic Review and Meta-Analysis.'. Endoscopy International Open 2021; 9 (10): E1314-E1322
• 3 Bhatia S.. et al. 'Endoscopic Ultrasound-Guided Rendezvous Technique vs Precut Sphincterotomy for Biliary Access: A Randomized Controlled Trial.'. Gastrointestinal Endoscopy 2020; 92 (4): 829-837