Optimization of ERCP with Rendez-vous Technique: Efficacy of Endoscopic Ultrasound and Percutaneous Biliary Approach in Mexico

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for endoscopic management of pancreaticobiliary disorders. However, alternative endoscopic approaches, such as endoscopic ultrasound (EUS) and percutaneous access, are available with a rendezvous (RV) approach. This method has been primarily employed as a rescue therapy following failed ERCP. The present study reports our experience utilizing the RV technique in a tertiary care center in Mexico City.

Methods To evaluate the technical and clinical success of the RV approach using EUS-assisted rendezvous (EUS-RV) and percutaneous biliary access (percutaneous transhepatic catheter and T tube) as a primary procedure or as an alternative to failed ERCP in benign and malignant obstruction. Data analysis was performed using descriptive and inferential statistics with VassarStats 2023 and Excel v2401. A retrospective, observational, cross-sectional study was conducted from 2022 to 2024 at the Centro Médico Nacional 20 de Noviembre ISSSTE, including 24 patients who underwent the RV approach out of a total of 683 ERCP procedures performed. The ERCPs were conducted using a Fujifilm duodenoscope (ED-530XT). For EUS-RV, a Fujifilm ultrasound endoscope (EG580UT) was used, along with a hydrophilic guidewire (Jagwire) of 0.025 and 0.035 inches for cannulation via percutaneous transhepatic catheter (PTC), T-tube (TT), and EUS-RV. Clinical and technical success was assessed based on the criteria established by the 2022 European Society of Gastrointestinal Endoscopy (ESGE) Guideline [1] [2] [3].

Results Over 683 ERCPs procedures RV approach was performed either on the same day as the failed ERCP or on subsequent days, depending on the patient’s condition. The mean age was 68.70±13.45, gender female 62.5% predominant. Of the 24 RV procedures performed, 7 were conducted by TT, 7 by PTC, and 10 using EUS-RV (one-way ANOVA=0.512). The primary indication was choledocholithiasis (50%). The malignant cases were pancreatic cancer and cholangiocarcinoma accounting for 20.8% and 16.6%, respectively. The most frequent access approach was EUS-RV; with an overall technical success (TS) rate of 83.3% vs clinical success (CS) rate of 66.6%, with a statistically significant difference for TS in the proportion difference analysis (p=<0.0002). By subgroups, benign vs malignant the TS was 86.6% vs 77.7 and CS 33.3% vs 66.6%, being higher over malignant cases. No statistically significant difference was identified between CS and TS depending on the etiology proportions. However, the percentage of CS rate was higher over malignant ones.

Conclusions The RV procedure is an effective and safe strategy for managing difficult ERCP, demonstrating a technical success rate exceeding 80% in our series. The EUS-RV approach demonstrated a higher rate of CS and TS rather than via TT and PTC. Further prospective studies are needed in our country to enhance the level of evidence and guide clinical decision-making for our patients.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Gornals JB, Sumalla-Garcia A, Quintana S. et al. Endoscopic ultrasound-guided biliary rendezvous after failed cannulation, and comparison between benign vs malignant biliopancreatic disorders: outcomes at a single tertiary-care centre Ann Med. 2024; 56 (1) 2416607.
• 2 Okuno N, Hara K, Mizuno N. et al. Endoscopic Ultrasound-guided Rendezvous Technique after Failed Endoscopic Retrograde Cholangiopancreatography: Which Approach Route Is the Best?. Intern Med 2017; 56 (23): 3135-3143
• 3 Van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022; 54 (2): 185-205