Endoscopic Ultrasound-guided Rendezvous Technique Versus Early Precut Papillotomy for Difficult Bile Duct Cannulation During Endoscopic Retrograde Cholangiopancreatography A Multicenter Randomized Controlled Trial

What this Trial Is About

Researchers are evaluating two advanced techniques to improve bile duct access during endoscopic retrograde cholangiopancreatography (ERCP) for patients with pancreatobiliary diseases. This study compares endoscopic ultrasound-guided rendezvous (EUS RV), a newer method, with early precut papillotomy, an established technique, to address the challenge of difficult bile duct cannulation which occurs in about 15% of cases. The goal is to determine which approach offers better success and fewer complications during ERCP procedures. One group of participants will receive the EUS-guided rendezvous technique, involving the use of an echoendoscope to locate the bile duct for guidewire insertion, followed by standard ERCP to complete access. The other group will undergo early precut papillotomy, where one of three standard needle knife or papillotome techniques is applied to gain bile duct entry. Both procedures are advanced endoscopic methods performed by experienced specialists, with the choice of specific approaches tailored to patient anatomy and institutional practice. During the study, participants will be monitored for technical success in accessing the bile duct during their first ERCP session. Researchers will also assess procedure-related serious adverse events up to 30 days after ERCP, the time taken to achieve biliary access, and the need for additional rescue procedures if access fails. The study involves detailed clinical evaluations and follow-up to compare the safety and effectiveness of these two key endoscopic biliary access techniques over the course of treatment and recovery.

Endoscopic Ultrasound-guided Rendezvous Versus Precut Papillotomy