EUS-guided rendezvous is a viable salvage technique for failed billiary cannulation in patients with Roux-en-Y gastric bypass undergoing BAE-ERCP.

Background and study aims: Biliary cannulation via balloon-assisted-ERCP (BAE-ERCP) can be challenging. Patients with Roux-en-Y gastric bypass (RYGB) have among the lowest reported BAE-ERCP success rates when compared with other types of surgically altered anatomy. We explored the role of EUS-guided rendezvous (EUS-RV) as a rescue technique when BAE-ERCP fails.

Patients and methods: Consecutive patients with RYGB underwent BAE-ERCP for both benign and malignant indications. Among them, patients in whom BAE-ERCP failed despite use of conventional advanced biliary cannulation techniques underwent EUS-RV if the ampulla could be reached.

Results: Forty-three consecutive patients with RYGB underwent BAE-ERCP. The procedure was successful in 30 patients (69.7%). Among the 13 patients with failed ERCP, EUS-RV was performed in five. Technical success was achieved in all five patients (100%), thereby increasing the overall BAE-ERCP success to 35 patients (81.3%). There were no major procedure-related adverse events on immediate and 3-month follow-up. Average total procedure time for failed BAE-ERCP followed by EUS-RV was 129 minutes (range 47-205 minutes).

Conclusions: EUS-RV in patients with RYGB has high technical and clinical success and can be a viable alternative to more invasive options when BAE-ERCP fails using traditional cannulation techniques.