Amna Iqbal, MD1, Zohaib Ahmad, MD1, Rehmat Ullah Awan, MD2, Nooraldin Merza, MD1, Yousaf Zafar, MD3, Sophia Haroon Dar, MD4, Mohamad I.. Itani, MD5, Mona Hassan, MD1, Abdallah A. Kobeissy, MD1 1University of Toledo, Toledo, OH; 2Ochsner Rush Medical Center, Meridian, MS; 3University of Mississippi Medical Center, Jackson, MS; 4Northshore-Long Island Jewish Medical Center, New York, NY; 5Detroit Medical Center/Wayne State University, Detroit, MI
Introduction: Various endoscopic techniques are employed to achieve biliary cannulation when confronted with difficult biliary access. Every procedure carries its own risk in terms of bleeding, infection, pancreatitis, cholangitis etc. Our meta-analysis aims to compare pre-cut papillotomy and EUS-Rendezvous in terms of technical success of the procedure and post-procedure pancreatitis and bleeding.
Methods: We conducted a systematic review and meta-analysis of studies that compared pre-cut papillotomy and EUS-Rendezvous. The primary outcome was technical success by achieving biliary cannulation. Secondary outcomes were postoperative pancreatitis and bleeding. A random-effects model was used to calculate the risk ratios (RR), mean differences (MD), and confidence intervals (CI). A P-value < 0.05 was considered statistically significant.
Results: We included 3 studies comparing pre-cut papillotomy and EUS Rendezvous. Both procedures were similar in terms of clinical success (RR 0.98, 95%CI 0.94-1.02). No difference was found between rates of post procedure pancreatitis (RR 1.60, 95% CI 0.52, 4.94) and post procedure bleeding (RR 3.94, 95% CI 0.53, 29.39).
Discussion: No difference in terms of technical success of procedure or post procedure pancreatitis and bleeding was found between pre-cut papillotomy and EUS-Rendezvous technique. More RCTs are needed to compare both techniques and complications but currently both procedures are accepted and safe when tackling DBC in the hands of experienced endoscopists.
Figure: Forrest Plot comparing technical success (A), post procedure pancreatitis (B), bleeding rate (C) between pre-cut papillotomy and EUS- Rendezvous technique for Difficult Biliary Cannulation (DBC)
Disclosures:
Amna Iqbal indicated no relevant financial relationships.
Zohaib Ahmad indicated no relevant financial relationships.
Rehmat Ullah Awan indicated no relevant financial relationships.
Nooraldin Merza indicated no relevant financial relationships.
Yousaf Zafar indicated no relevant financial relationships.
Sophia Haroon Dar indicated no relevant financial relationships.
Mohamad Itani indicated no relevant financial relationships.
Mona Hassan indicated no relevant financial relationships.
Abdallah Kobeissy indicated no relevant financial relationships.
Amna Iqbal, MD1, Zohaib Ahmad, MD1, Rehmat Ullah Awan, MD2, Nooraldin Merza, MD1, Yousaf Zafar, MD3, Sophia Haroon Dar, MD4, Mohamad I.. Itani, MD5, Mona Hassan, MD1, Abdallah A. Kobeissy, MD1. P0853 - Pre-Cut Papillotomy vs Endoscopic Ultrasound (EUS) Rendezvous for Difficult Biliary Cannulation (DBC): A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
