Efficacy and safety of EUS-guided Rendezvous after failed ERCP. Retrospective comparison in malignant versus benign biliary disease.

backgroundERCP is the standard technique for biliary drainage, but cannulation may fail, particularly in malignant biliary obstruction (MBO). The efficacy and safety of EUS-guided rendezvous (EUS-RV) in MBO remain uncertain compared with benign disease.

methodsThis a single-centre retrospective study based on a prospectively updated database in a tertiary hospital. Consecutive biliary EUS-RV cases after unsuccessful ERCP of any aetiology were included. Patients with inaccessible papilla due to surgically altered upper gastrointestinal anatomy or duodenal stricture were excluded. Adverse events (AE) that occurred as a consequence of the procedural intervention were defined as intraprocedural AE.

resultsA total of 165 biliary EUS-RV procedures were performed between October 2011 and August 2024 in our centre and were included. EUS-RV was performed in 49 patients with malignant biliary obstruction (MBO) and in 116 patients with benign diseases. No significant differences in technical success were observed between patients with MBO and those with benign disease (83.7% vs 82.8%, p = 0.89). Intraprocedural adverse events were significantly increased in MBO: 12.2% vs 2.6% in benign aetiology, p = 0.021. Patients with MBO showed a significantly higher incidence of intraprocedural AEs when 19 G needles were used compared to 22 G needles (23.1% vs 0%, p = 0.016). This difference was not observed in patients with benign diseases: 7.1% vs 2%, p = 0.32.

conclusionEUS-RV is an effective and safe technique after failed ERCP in both malignant and benign pathology. In patients with MBO the use of a 22G needle for EUS-RV could be preferred as it significantly reduces adverse events.