Modified Versus Conventional Technique of Endoscopic Ultrasound‐Guided Rendezvous to Access the Narrow Bile Duct in Patients With Benign Biliary Diseases With Difficult Bile Duct Cannulation: A Comparative Feasibility Assessment Study

Background Extrahepatic endoscopic ultrasound‐guided rendezvous (EUS‐RV) with narrow common bile duct (CBD), as encountered in benign biliary diseases, can be technically challenging. We evaluated its modification (no aspiration, no contrast) in this difficult clinical scenario. Methods EUS‐RV using conventional versus modified technique in patients with benign diseases and narrow CBD (≤ 6 mm) with difficult biliary cannulation (European Society of Gastrointestinal Endoscopy definition) was evaluated. The primary outcome was technical success, and secondary outcomes were overall EUS‐RV core time, radiation dose, and adverse events. Results Overall, 113 patients were evaluated (conventional 49; modified 64). The modified EUS‐RV had numerically higher technical success (83.7% vs. 95.3%; p = 0.05), which was significantly higher when the CBD access diameter was ≤ 3 mm (61.1% vs. 96.9%; p = 0.002). Moreover, the modified EUS‐RV had shorter total core EUS‐RV time (median 10 vs. 6.12 min; p < 0.001) and overall radiation exposure (median 345 vs. 208.93 mGy; p < 0.001), with comparable overall adverse events. On multivariate analysis, the predictors for technical success were the use of the modified technique (aOR: 6.26; p = 0.02) and CBD access diameter (aOR: 5.56; p = 0.04). Conclusions Modified EUS‐RV technique enables efficient and rapid biliary access in cases of narrowed CBD without the need for contrast injection and bile aspiration.