Endoscopic ultrasound–guided rendezvous (EUS-RV) is an alternative when ERCP fails. However, no studies have evaluated its learning curve. The aim of this study was to analyze the learning curve of biliary EUS-RV in a tertiary center.

A retrospective study was conducted of all consecutive biliary EUS-RV procedures performed by two endoscopists in a tertiary hospital between 2011 and 2025. Learning curves were assessed through binomial analysis of cumulative rates of technical success and adverse events (AEs), using thresholds of 80% and 14%, respectively. Additionally, CUSUM curves of procedure time were generated.

A total of 190 biliary EUS-RV procedures were included, 149 (78.4%) performed by physician 1 and 41 (21.6%) by physician 2. In 56 cases (29.5%), biliary obstruction was due to a malignant condition, and in 134 cases (70.5%), the etiology was benign. Overall technical success was 83.7%, with no significant differences between the two physicians (84.6% vs 80.5%, p=0.5). Technical success by quartiles showed a significant increase over time, reaching 98% in the last quartile vs 74.5% in the first (p=0.009). The overall learning curve indicates that 60 to 70 cases are required to reach the 80% success threshold, while 150 cases are needed to consistently maintain success rates above 80%, though without statistical significance. When analyzing each physician independently, physician 2 reached the technical success threshold after 40 cases. The CUSUM curve for procedure time showed a reduction at 80–90 cases, stabilizing at 130 cases.A total of 25 AEs (13.2%) were recorded, remaining stable with a slight decrease toward the end of the series.

EUS-RV demonstrates a prolonged learning curve, requiring a high number of procedures to achieve an adequate level of proficiency. Adverse events remain stable and appear unaffected by the learning process. The introduction of the technique in a center may influence the learning curve of subsequent endoscopists.