Endoscopic ultrasound-guided biliary rendezvous after failed cannulation, and comparison between benign vs malignant biliopancreatic disorders: outcomes at a single tertiary-care centre

Endoscopic ultrasound (EUS)-guided biliary rendezvous (RV) is an EUS-assisted technique described as a rescue method in cases of failed biliary cannulation <i>via</i> endoscopic retrograde cholangiography (ERC). Current literature remains unclear regarding its current role. The study aim was to evaluate the effectiveness for biliary EUS-RV, and comparison between benign vs malignant biliopancreatic disorders. Retrospective observational study with prospective consecutive inclusion in a specific database from a tertiary-center. All patients with biliopancreatic diseases that underwent a EUS-assisted ERC between October-2010 and November-2022 for failed ERC were included. Main outcomes were technical/overall success. Secondary outcomes were safety, potential factors related to failure/success or safety; and a comparative analysis between EUS-RV and EUS-guided transmural drainage (TMD) in malignant cases. A total of 69 patients who underwent EUS-RV procedures, with benign and malignant pathologies (<i>n</i> = 40 vs <i>n</i> = 29), were included. Technical / overall success and related-adverse events (AEs) were 79.7% (95%CI, 68.3-88.4) / 74% (95%CI, 61-83.7) and 24% (95%CI, 15.1-36.5), respectively. Failed cases were mainly related with guidewire manipulation. Seven failed RV were successfully rescued by EUS-TMD. On multivariable analysis, EUS-RV and malignant pathology was associated with a greater failure rate (technical success: OR,0.21; 95%CI,0.05-0.72; <i>p</i> = 0.017), and higher AEs rate (OR,3.46; 95%CI,1.13-11.5; <i>p</i> = 0.034). Also, the EUS-TMD group had greater technical success (OR,16.96; 95%CI,4.69-81.62; <i>p</i> &lt; 0.001) and overall success (OR, 3.09; 95%CI,1.18-8-16; <i>p</i> &lt; 0.026) with a lower AEs rate (OR,0.30; 95%CI,0.11-0.78; <i>p</i> = 0.014) than EUS-RV in malignant disorders. EUS-RV is a demanding technique with better outcomes in benign than in malignant biliopancreatic diseases. Comparison of the EUS-TMD group on malignant disorders showed worse outcomes with EUS-RV. Given these findings, maybe EUS-RV is not the best option for malignant biliopancreatic disorders. Last international guidelines suggest Endoscopic Ultrasound (EUS)-guided assisted bile duct access (or biliary <i>rendezvous</i>) after a second failed Endoscopic Retrograde Cholangiography (ERC) in benign biliary disease, in high volume centers, but its current role in malignant disease is unclear.This study provides a larger number of EUS-guided biliary <i>rendezvous</i> cases than reported in previous studies, and offers new and relevant information, not available in the last clinical guidelines or systematic reviewsThe EUS-guided biliary <i>rendezvous</i> associates better effectiveness in benign than in malignant biliopancreatic disorders. When comparing EUS-guided <i>rendezvous</i> with EUS-biliary transmural drainage in malignant diseases, rendezvous has a lower success, and higher adverse events. Therefore, maybe EUS-guided <i>rendezvous</i> is not the best option for malignant disorders and might be reserved for benign cases. Last international guidelines suggest Endoscopic Ultrasound (EUS)-guided assisted bile duct access (or biliary <i>rendezvous</i>) after a second failed Endoscopic Retrograde Cholangiography (ERC) in benign biliary disease, in high volume centers, but its current role in malignant disease is unclear. This study provides a larger number of EUS-guided biliary <i>rendezvous</i> cases than reported in previous studies, and offers new and relevant information, not available in the last clinical guidelines or systematic reviews The EUS-guided biliary <i>rendezvous</i> associates better effectiveness in benign than in malignant biliopancreatic disorders. When comparing EUS-guided <i>rendezvous</i> with EUS-biliary transmural drainage in malignant diseases, rendezvous has a lower success, and higher adverse events. Therefore, maybe EUS-guided <i>rendezvous</i> is not the best option for malignant disorders and might be reserved for benign cases.