Nine Cases of EUS-Guided Rendezvous Technique Using a Forward-Viewing Endoscope in Patients with Difficulty Reaching the Papilla of Vater or Hepaticojejunostomy Anastomosis with a Duodenoscope

Background: EUS-guided rendezvous technique (EUS-RV) is a salvage procedure for difficult biliary cannulation by ERCP. However, in cases with duodenal stenosis or surgically altered anatomy, using a duodenoscope for EUS-RV is difficult. A forward-viewing endoscope, such as a single-balloon endoscope, may offer an alternative for transpapillary biliary procedures in such cases. Reports on this approach are limited. This study evaluates the outcomes of nine cases where EUS-RV was performed using a forward-viewing endoscope.
Methods: From November 2018 to February 2025, nine EUS-RV cases using a forward-viewing endoscope were analyzed. Technical success (successful bile duct cannulation), clinical success (completion of biliary procedures), cannulation time (time from failure with ERCP to successful cannulation), and adverse events were retrospectively analyzed.
Results: The median age of patients was 82 years (3 males, 6 females). Primary diseases included common bile duct stones (n=3), hepaticojejunostomy anastomosis stricture (n=2), pancreatic cancer (n=2), and other malignant biliary obstructions (n=2). The forward-viewing endoscope was used due to duodenal stenosis (n=5) and surgically altered anatomy (n=4). Both technical and clinical success rates were 100%. Average cannulation time was 34 minutes for duodenal stenosis and 36 minutes for altered anatomy cases. No EUS-RV-related adverse events occurred.
Conclusion: EUS-RV using a forward-viewing endoscope is an effective technique for transpapillary biliary procedures in patients with duodenal stenosis or surgically altered anatomy.