{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:02:04Z","timestamp":1783519324944,"version":"3.55.0"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Difficult biliary cannulation (DBC) is a marker for prolonged procedure time and a higher rate of adverse events (AEs) during endoscopic retrograde cholangiopancreatography (ERCP). We previously showed that endoscopic ultrasound-assisted rendezvous (EUS-RV) procedures had a higher single-session success rate than precut papillotomy (PCP) in cases of DBC. The present randomized study aimed to compare the technical success and AE rates of the two approaches<\/jats:p><jats:p>This was an open-label randomized controlled trial in a tertiary care setting. Patients with malignant distal biliary obstruction (MDBO) and DBC were enrolled. The patients were randomized to PCP with a needle-knife or EUS-RV. The primary outcome was technical success; secondary outcomes were the AE rate, procedure duration, and length of hospital stay (LOS).<\/jats:p><jats:p>208 patients were enrolled, 104 in each group. There were no statistically significant differences in technical success (93.3% PCP vs. 97.1% EUS-RV; P = 0.33; odds ratio [OR] 0.4, 95%CI 0.1\u20131.6) and overall AE rate (11.5% PCP vs. 5.8% EUS-RV; P=0.14; OR 0.5, 95%CI 0.8\u20135.9). Pancreatitis was higher in the PCP group (8.7% vs. 1.9%; P=0.06; OR 4.8, 95%CI 1.0\u201322.9). The mean duration of the procedure was significantly higher for EUS-RV (47 vs. 27 minutes; P&lt;0.001). LOS was similar in the two groups (1.2 PCP vs. 1.1 days EUS-RV; P=0.25).<\/jats:p><jats:p>Both PCP and EUS-RV have comparable rates of success, AEs, mortality, and LOS. EUS-RV could be used as an alternative to PCP in patients with MDBO and DBC.<\/jats:p>","DOI":"10.1055\/a-2515-1712","type":"journal-article","created":{"date-parts":[[2025,1,12]],"date-time":"2025-01-12T18:30:21Z","timestamp":1736706621000},"page":"1077-1084","source":"Crossref","is-referenced-by-count":18,"title":["Randomized comparison of precut papillotomy versus an endoscopic ultrasound-guided rendezvous procedure for difficult biliary access in malignant distal biliary obstruction"],"prefix":"10.1055","volume":"57","clinical-trial-number":[{"clinical-trial-number":"ctri\/2012\/12\/003248","registry":"10.18810\/clinical-trial-registry-india"}],"author":[{"given":"Vinay","family":"Dhir","sequence":"additional","affiliation":[{"name":"Endoscopy, Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Endoscopy, Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5729-8897","authenticated-orcid":false,"given":"Ankit","family":"Dalal","sequence":"additional","affiliation":[{"name":"Endoscopy, Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav Kumar","family":"Patil","sequence":"additional","affiliation":[{"name":"Endoscopy, Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1687-4936","authenticated-orcid":false,"given":"Amit","family":"Maydeo","sequence":"additional","affiliation":[{"name":"Endoscopy, Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, 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