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.
