S110 Comparison of Endoscopic Ultrasound-Guided Rendezvous and Precut Papillotomy for Biliary Access: A Meta-Analysis of Randomized Trials

Introduction: When endoscopic retrograde cholangiopancreatography (ERCP) fails, alternative techniques such as endoscopic ultrasound-guided rendezvous (EUS-RV) and precut papillotomy are employed for biliary access. This study compares the effectiveness and safety of these 2 approaches. Methods: We conducted a comprehensive search in PubMed, Embase, Cochrane, and Web of Science from inception until February 2025 for RCTs comparing EUS-RV and precut papillotomy. Primary outcomes included technical success rate, clinical success rate, adverse events, and procedure time. Secondary outcomes included rate of post-ERCP pancreatitis, bleeding, and length of hospital stay. A random effects model was used and the data was presented using pooled odds ratios (OR) or mean differences with 95% confidence intervals (CI). Results: This study included 6 studies (4 retrospective cohort studies and 2 randomized controlled trials) with a total of 1,415 patients. EUS-RV demonstrated significantly higher technical success rates (OR 2.69, 95% CI 1.55-4.68, P = 0.0004) and a reduced risk of post-ERCP pancreatitis (OR 0.40, 95% CI 0.18-0.90, P = 0.0263) compared to precut papillotomy. No significant differences were found in overall adverse events (OR 1.09, 95% CI 0.35-3.38, P = 0.8871), bleeding (OR 0.45, 95% CI 0.14-1.38, P = 0.1618), or procedure time (standardized mean difference 0.42, 95% CI -0.98 to 1.83, P = 0.5539). Conclusion: EUS-RV appears to offer superior effectiveness and safety for biliary access following failed ERCP, with higher technical success and a lower incidence of pancreatitis.