Technical overview of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography: A guide for the endoscopist

Table 3 Studies (randomized controlled trials) comparing endoscopic ultrasound guided rendezvous technique with needle knife precut papillotomy, n (%)/mean ± SD

Ref.	Definition of DBC	Endoscopist experience	Sample size	Baseline characteristics; age, years	Baseline characteristics; gender (male %)	Groups (n)	Successful CBD cannulation	Bleeding	Perforation	PEP	Comments
Choudhury et al[53], 2024	No cannulation after 5 minutes; > 5 contacts with papilla; > 1 unintended PD cannulation	Well versed with both ERCP and EUS-RV	100	EUS-RV: 50.52 (12.8); NKPP: 52.96 (15.7)	EUS-RV: 15 (30); NKPP: 13 (26)	EUS-RV: 50; NKPP: 50	EUS-RV: 92; NKPP: 90	0	0	EUS-RV: 5 (10); NKPP: 5 (10)
Dhir et al[54], 2025	No cannulation after 5 attempts, time > 5 minutes. All cases of distal biliary malignant obstruction	Not defined	208	NKPP: 64 (34-90); EUS-RV: 67 (42-84)	NKPP: 65 (62.2) EUS-RV: 57 (54.8)	NKPP: 104; EUS-RV: 104	NKPP: 97 (93.3); EUS-RV: 101 (97.1)	NKPP: 3 (2.9); EUS-RV: 2 (1.9)	NKPP: 0; EUS-RV: 0	NKPP: 9 (8.7); EUS-RV: 2 (1.9)	2 bile duct leak (1.9) in EUS-RV group

DBC: Difficult biliary cannulation; CBD: Common bile duct; PEP: Post endoscopic retrograde cholangiopancreatography pancreatitis; PD: Pancreatic duct; ERCP: Endoscopic retrograde cholangiopancreatography; NKPP: Needle knife precut papillotomy; EUS-RV: Endoscopic ultrasound guided rendezvous.