title: Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction.
abstract: BACKGROUND
  EUS-guided rendezvous procedure (EUS-RV) can be done by the transhepatic (TH) or the extrahepatic (EH) route. There is no data on the preferred access route when both routes are available.
  
  
  OBJECTIVE
  To compare the success, complications, and duration of hospitalization for patients undergoing EUS-RV by the TH or the EH route.
  
  
  METHODS
  Patients with distal common bile duct (CBD) obstruction, who failed selective cannulation, underwent EUS-RV by the TH route through the stomach or the EH route through the duodenum.
  
  
  RESULTS
  A total of 35 patients were analysed (17 TH, 18 EH). The mean procedure time was significantly longer for the TH group (34.4 vs. 25.7 min; p = 0.0004). There was no difference in the technical success (94.1 vs. 100%). However, the TH group had a higher incidence of post-procedure pain (44.1 vs. 5.5%; p = 0.017), bile leak (11.7 vs. 0; p = 0.228), and air under diaphragm (11.7 vs. 0; p = 0.228). All bile leaks were small and managed conservatively. Duration of hospitalization was significantly higher for the TH group (2.52 vs. 0.17 days; p = 0.015).
  
  
  CONCLUSIONS
  EUS-RV has similar success rate by the TH or the EH route. However, the TH route has higher post-procedure pain, longer procedure time, and longer duration of hospitalization. The EH route should be preferred for EUS-RV in patients with distal CBD obstruction when both access routes are technically feasible.
authors.affiliation: Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Suryaprakash
authors.initials: S
authors.lastname: Bhandari
authors.affiliation: Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Mukta
authors.initials: M
authors.lastname: Bapat
authors.affiliation: Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Joshi
authors.affiliation: Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Suhirdan
authors.initials: S
authors.lastname: Vivekanandarajah
authors.affiliation: Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Maydeo
keywords: Biliary; ERCP; endosonography; precut; rendezvous; stent