EUS-RV as good as precut sphincterotomy in patients with difficult biliary cannulation

Endoscopic ultrasound (US)-guided rendezvous (EUS-RV) technique is on a par with precut sphincterotomy as a salvage technique for patients with difficult bile duct cannulation for benign biliary disease, a study has shown. The complications rates for the two approaches are both acceptable. 

Investigators performed this randomized controlled trial at a tertiary care academic institute from July 2020 to May 2021. A hundred patients with benign biliary disease and difficult bile duct cannulation requiring salvage strategy were randomly assigned to either EUR-RV (n=50) or precut sphincterotomy (n=50). Those with failure in EUS-RV were switched to precut sphincterotomy and vice versa. 

The two salvage techniques demonstrated similar technical success rates (92 percent vs 90 percent; p=1.00; relative risk [RR], 1.02, 95 percent confidence interval [CI], 0.90−1.16), median procedure time (10.1 vs 9.75 min), and overall complication rates (12 percent vs 10 percent; RR, 1.20, 95 percent CI, 0.39−3.68). 

Notably, postendoscopic retrograde cholangiopancreatography pancreatitis occurred in five patients (10 percent) in the EUS-RV arm and in five (10 percent) individuals in the precut sphincterotomy arm. Failed cases in either group were successfully cannulated when switched to the other group. 

This study was limited by its single-centre design. 

“The standard salvage technique used for difficult bile duct cannulation is precut sphincterotomy, whereas EUS-RV is a relatively newer method,” the investigators said.