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.
Endoscopy_UCTN_Code_TTT_1AR_2AF
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