Modified Versus Conventional Technique of Endoscopic Ultrasound-Guided Rendezvous to Access the Narrow Bile Duct in Patients With Benign Biliary Diseases With Difficult Bile Duct Cannulation: A Comparative Feasibility Assessment Study.

Abstract

Background: Extrahepatic endoscopic ultrasound-guided rendezvous (EUS-RV) with narrow common bile duct (CBD), as encountered in benign biliary diseases, can be technically challenging. We evaluated its modification (no aspiration, no contrast) in this difficult clinical scenario.

Methods: EUS-RV using conventional versus modified technique in patients with benign diseases and narrow CBD (≤ 6 mm) with difficult biliary cannulation (European Society of Gastrointestinal Endoscopy definition) was evaluated. The primary outcome was technical success, and secondary outcomes were overall EUS-RV core time, radiation dose, and adverse events.

Results: Overall, 113 patients were evaluated (conventional 49; modified 64). The modified EUS-RV had numerically higher technical success (83.7% vs. 95.3%; p = 0.05), which was significantly higher when the CBD access diameter was ≤ 3 mm (61.1% vs. 96.9%; p = 0.002). Moreover, the modified EUS-RV had shorter total core EUS-RV time (median 10 vs. 6.12 min; p < 0.001) and overall radiation exposure (median 345 vs. 208.93 mGy; p < 0.001), with comparable overall adverse events. On multivariate analysis, the predictors for technical success were the use of the modified technique (aOR: 6.26; p = 0.02) and CBD access diameter (aOR: 5.56; p = 0.04).

Conclusions: Modified EUS-RV technique enables efficient and rapid biliary access in cases of narrowed CBD without the need for contrast injection and bile aspiration.