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Objectives: We aimed to evaluate the efficacy and safety of metal stents compared with plastic stents when bilateral side‐by‐side stents were deployed for malignant hilar biliary obstruction (MHBO). Methods: Fifty patients with unresectable advanced MHBO were randomly assigned to the metal stent (MS, n = 25) or plastic stent group (PS, n = 25). Fully covered self‐expandable metal stents with 6 mm diameter and plastic stents with either 7F straight or double pigtail were used for MS and PS groups, respectively. Time to recurrent biliary obstruction (TRBO) was evaluated as the primary outcome. Results: Both groups had 100% technical success rates; 88% and 76% of clinical success rates were obtained in MS and PS, respectively. Although stent migrations were more frequent in MS than PS (48% vs. 16%, P = 0.02), the mean TRBO was significantly longer in MS (190 days; 95% confidence interval [CI] 121–260 days vs. 96 days; 95% CI 50–141 days, P = 0.02). The placement of plastic stents (hazard ratio 2.42; 95% CI 1.24–4.73; P = 0.01) was the only significant risk factor associated with TRBO in multivariable analysis. The rates of adverse events were similar between the two groups (difference 0%; 95% CI −25% to 25%; P > 0.99). Conclusions: During bilateral side‐by‐side deployment in MHBO, the use of metal stents appears to be preferable to plastic stents in terms of TRBO, despite a higher frequency of stent migration. [ABSTRACT FROM AUTHOR]

Objectives: Endoscopic ultrasound (EUS) or percutaneous‐assisted antegrade guidewire insertion can be used to achieve biliary access when standard endoscopic retrograde cholangiopancreatography (ERCP) fails. We conducted a systematic review and meta‐analysis to evaluate and compare the effectiveness and safety of EUS‐assisted rendezvous (EUS‐RV) and percutaneous rendezvous (PERC‐RV) ERCP. Methods: We searched multiple databases from inception to September 2022 to identify studies reporting on EUS‐RV and PERC‐RV in failed ERCP. A random‐effects model was used to summarize the pooled rates of technical success and adverse events with 95% confidence interval (CI). Results: In total, 524 patients (19 studies) and 591 patients (12 studies) were managed by EUS‐RV and PERC‐RV, respectively. The pooled technical successes were 88.7% (95% CI 84.6–92.8%, I2 = 70.5%) for EUS‐RV and 94.1% (95% CI 91.1–97.1%, I2 = 59.2%) for PERC‐RV (P = 0.088). The technical success rates of EUS‐RV and PERC‐RV were comparable in subgroups of benign diseases (89.2% vs. 95.8%, P = 0.068), malignant diseases (90.3% vs. 95.5%, P = 0.193), and normal anatomy (90.7% vs. 95.9%, P = 0.240). However, patients with surgically altered anatomy had poorer technical success after EUS‐RV than after PERC‐RV (58.7% vs. 93.1%, P = 0.036). The pooled rates of overall adverse events were 9.8% for EUS‐RV and 13.4% for PERC‐RV (P = 0.686). Conclusions: Both EUS‐RV and PERC‐RV have exhibited high technical success rates. When standard ERCP fails, EUS‐RV and PERC‐RV are comparably effective rescue techniques if adequate expertise and facilities are feasible. However, in patients with surgically altered anatomy, PERC‐RV might be the preferred choice over EUS‐RV because of its higher technical success rate. [ABSTRACT FROM AUTHOR]

Background: The torque and fanning techniques allow for multiple areas within pancreatic lesions to be targeted using different maneuvers and can, hence, enhance diagnostic outcomes. We compared the diagnostic performance of endoscopic ultrasound‐guided fine‐needle biopsy (EUS‐FNB) for pancreatic masses using the torque and fanning techniques. Methods: This multicenter randomized trial enrolled a total of 160 consecutive patients who underwent EUS‐FNB for solid pancreatic tumors using either the torque or fanning technique. Three passes were permitted for each lesion, and the technique sequence was randomly assigned as either torque first or fanning first with the standard technique as a reference. Results: The median quality score of the histological samples was significantly higher in the torque and fanning group than in the standard group (p <.001). Furthermore, the torque technique provided improved sensitivity of 93.38% and accuracy of 94.30%. The standard technique provided diagnostic sensitivity of 68.84% and accuracy of 72.96%, while the fanning technique showed sensitivity of 91.85% and accuracy of 93.04%. Conclusions: The new torque technique enables the acquisition of better‐quality samples and can potentially increase the diagnostic outcomes in the EUS‐FNB of pancreatic solid masses, with the same recommendations as those for the fanning technique. [ABSTRACT FROM AUTHOR]