Abstract
Endoscopic Ultrasound-guided Rendezvous Technique versus Precut Sphincterotomy as Salvage Technique for Biliary Access: A Meta-Analysis
Ma. Regina Dimaculangan, MD; Nikko Theodore Raymundo, MD; Joseph Erwin Dumagpi, MD; Juliet Gopez-Cervantes, MD
St. Luke’s Medical Center – Global City
Significance: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment for obstructive jaundice, with a 90% success rate. However, common bile duct cannulation fails in up to 10% of cases. The standard salvage technique for difficult cannulation is precut sphincterotomy, while the endoscopic ultrasound-guided rendezvous (EUS-RV) technique is a newer alternative. EUS-RV involves puncturing the bile duct using EUS guidance and maneuvering the guidewire across the papilla before cannulation, whereas precut sphincterotomy entails a deliberate incision to facilitate cannulation. Despite their clinical use, the comparative effectiveness of these methods remains unclear. This meta-analysis evaluates and compares the outcomes of EUS-RV and precut sphincterotomy as salvage techniques for biliary access.
Methodology: A search of major electronic databases and grey literature up to August 2024 identified randomized controlled trials and cohort studies. Three studies (Dhir 2012, Choudhury 2021, Ko and Su 2024) were included in the analysis, with RevMan 5.4 used for statistical computation.
Results: The success rates for EUS-RV and precut sphincterotomy were compared. The pooled odds ratio was 1.71 (95% CI 0.71–4.11), which was not statistically significant, indicating no difference between the two methods. The I² value of 0% (p=0.37) suggests no heterogeneity. Two studies (Choudhury 2021 and Ko and Su 2024) found that the techniques were complementary, with successful crossover cannulation.
Conclusion: Both EUS-RV and precut sphincterotomy are effective salvage techniques for biliary access, with no significant difference in success rates. The choice between them can depend on patient needs and the endoscopist’s expertise.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |