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CC BY 4.0 · Endoscopy 2025; 57(S 01): E1284-E1285
DOI: 10.1055/a-2719-3047
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A case of tumor-related hemobilia successfully treated with radiofrequency ablation diagnosed by peroral cholangioscopy

Authors

  • Takahiro Urata 

    1   Department of Gastroenterology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (Ringgold ID: RIN38346)

  • Shun Kawahara

    1   Department of Gastroenterology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (Ringgold ID: RIN38346)

  • Hideki Kitada

    1   Department of Gastroenterology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (Ringgold ID: RIN38346)
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Radiofrequency ablation (RFA) is a treatment that uses high frequency electrical current to induce coagulative necrosis of tumors. In the biliary tract, RFA has been reported as a palliative option to reduce tumor burden and maintain ductal patency, often combined with stenting; however, strong evidence supporting its efficacy remains limited [1] [2] [3]. Hemobilia, especially when tumor-related, presents significant diagnostic and therapeutic challenges and can be life-threatening. We report a case in which the bleeding source was identified via peroral cholangioscopy (POCS), and hemostasis was successfully achieved using RFA.

A 72-year-old man presented with persistent epigastric pain. Laboratory tests revealed elevated total bilirubin (4.2 mg/dL), AST (518 U/L), ALT (304 U/L), and ALP (228 U/L). Contrast-enhanced computed tomography (CT) showed a hypovascular tumor in segment 4 ([Fig. 1]) and a hyperdense area within the bile duct, suggestive of intraductal blood. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a radiolucent filling defect, which was removed using a balloon catheter and identified as a hematoma ([Fig. 2] a, b). Endoscopic nasobiliary drainage was performed to relieve jaundice and inflammation. Once jaundice improved, POCS revealed an exposed tumor in the left intrahepatic bile duct ([Fig. 3]), with ongoing tumor-related bleeding observed ([Video 1]). Biopsy confirmed adenocarcinoma.

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Fig. 1 Contrast-enhanced abdominal computed tomography showed a hypovascular tumor in hepatic segment 4.
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Fig. 2 a Endoscopic retrograde cholangiopancreatography showed a radiolucent area (arrowhead) in the bile duct. b The lesion was identified as a blood clot after removal with a balloon catheter.
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Fig. 3 Peroral cholangioscopy (POCS) revealed that the tumor was exposed to the lumen of the left intrahepatic bile duct.
Peroral cholangioscopy revealed tumor-related hemobilia, and hemostasis was achieved with repeated sessions of intraductal radiofrequency ablation.Video 1

RFA was performed using a Habib EndoHPB catheter (Boston Scientific, Marlborough, Massachusetts, USA). The first session was applied at 7 W for 90 seconds, then 10 W for 90 seconds. Follow-up POCS one week later showed partial tumor ablation but mild persistent bleeding. A second RFA session at 10 W for 90 seconds, repeated twice, achieved hemostasis ([Fig. 4], [Video 1]). The patient’s condition improved without anemia progression, and chemotherapy with gemcitabine and S-1 was initiated. No tumor-related bleeding recurred during seven months of follow-up.

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Fig. 4 POCS confirmed successful tumor ablation and hemostasis.

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Publication History

Article published online:
14 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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