Endoscopic radiofrequency ablation of a cholangiocarcinoma with targeted intraductal cholangioscopic access

Radiofrequency ablation (RFA) is a technique that has been used during endoscopic retrograde cholangiopancreatography (ERCP) for palliation of locally advanced biliary malignancies [1]. Direct cholangioscopy can be useful for confirming a successful response to therapy [2]. We present a case evaluating the feasibility of intraductal RFA using cholangioscopy (SpyGlass DS System) in a malignant biliary stricture [3].

An 83-year-old woman presented with a 1-month history of jaundice and weight loss. Her serum bilirubin level was 10.50 mg/dL. An abdominal computed tomography (CT) scan revealed an intrahepatic biliary dilatation and dilated (16 mm) common bile duct (CBD). ERCP showed a 2.5-cm tight distal CBD stricture with upstream biliary dilatation, and a fully covered metal stent was placed. Brush cytology confirmed the suspicion of cholangiocarcinoma.

Primary endobiliary RFA was offered to the patient and informed consent was obtained. The duodenoscope passed the ampulla and a cholangiogram showed the dilated biliary tree above the distal biliary stricture. A digital cholangioscope (SpyGlass) was inserted into the bile duct, and the stricture was visualized revealing a nodular lesion with irregular mucosa ([Video 1]). Intraductal RFA was performed advancing into the stricture, using 10 W for a time period of 2 minutes under 75 °C of intraductal temperature. The cholangioscope was reinserted and showed successfully ablated tissue with localized necrosis ([Fig. 1]). Finally, an uncovered metal stent was deployed (WallFlex; 10 × 60 mm) ([Video 1]). The patient was discharged the following day without any complications.

Video 1 Endobiliary radiofrequency ablation is used to treat an unresectable bile duct cancer.

Fig. 1 Images following reinsertion of the intraductal cholangioscope showing successfully ablated tissue with localized necrosis.

Endobiliary RFA that is targeted using cholangioscopy adds to the endoscopic armamentarium for the treatment of unresectable malignant obstructive neoplasms; moreover, it is possible to confirm the successful ablation of malignant strictures after RFA.

In conclusion, endobiliary RFA seems to be safe and effective as a treatment modality for unresectable bile duct cancer.

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Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Brown N, Camilo J, McCarter M. et al. Refractory jaundice from intraductal papillary mucinous neoplasm treated with cholangioscopy-guided radiofrequency ablation. ACG Case Rep J 2016; 3: 202-204
• 2 Tyberg A, Zerbo S, Sharaiha R. et al. Digital cholangioscopy: assessing the impact of radiofrequency ablation. Endoscopy 2015; 47 (Suppl. 01) E544
• 3 Mavrogenis G, Deprez P, Wallon J. et al. Bile duct adenoma causing recurrent cholangitis: diagnosis and management with targeted SpyGlass access and radiofrequency ablation. Endoscopy 2012; 44 (Suppl. 02) E290-E291

Publication History

Article published online:
19 June 2020