Modified endoscopic ultrasound-guided rendezvous shows promise for challenging biliary access in benign cases.

• Higher technical success rate with modified technique: 95.3% vs. 83.7%, especially effective with CBD diameter ≤ 3 mm (96.9% vs. 61.1%, p=0.002).
• Reduced procedure time: median of 6.12 minutes vs. 10 minutes (p<0.001) and lower radiation exposure (median 208.93 vs. 345 mGy, p<0.001).

Consider adopting the modified approach to enhance efficiency and safety in complex biliary cannulations.

• Predictors of success include using the modified technique and CBD diameter.