Background Endoscopic ultrasound (EUS)-guided biliary rendezvous (RV) is an EUS-assisted technique described as a rescue method in cases of failed biliary cannulation via endoscopic retrograde cholangiography (ERC). Current literature remains unclear regarding its current role. The study aim was to evaluate the effectiveness for EUS-guided biliary RV, and comparison between benign vs malignant biliopancreatic disorders. Methods Retrospective observational study with prospective consecutive inclusion in a specific database from a tertiary-center. All patients with biliopancratic disorders 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-guided RV and EUS-transmural drainage (TMD) in malignant cases. Results A total of 69 patients who underwent EUS-guided biliary RV procedures, with benign and malignant biliopancreatic pathologies (n=40 vs n=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; p=0.017), and higher AEs rate (OR,3.46; 95%CI,1.13-11.5; p=0.034). Also, the EUS-TMD group had greater technical success (OR,16.96; 95%CI,4.69-81.62; p<0.001) and overall success (OR, 3.09; 95%CI,1.18-8-16; p<0.026) with a lower AEs rate (OR,0.30; 95%CI,0.11-0.78; p=0.014) than EUS-RV in malignant disorders. Conclusions EUS-RV is a demanding technique with better outcomes in benign than in malignant biliopancreatic disorders. 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.

JBG is a consultant for Boston Scientific and has received a Fujifilm grant. The other authors have no conflicts of interest to disclose.

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