Laser ablation under intraductal cholangioscopic guidance for cholangiocarcinoma

An 82-year-old man was admitted for progressively worsening jaundice. Magnetic resonance cholangiopancreatography (MRCP) showed a stenosis of 2 cm in length in the common bile duct, with dilatation of the biliary system above ([Fig. 1]). Endoscopic retrograde cholangiopancreatography (ERCP)-guided cytologic brushing confirmed adenocarcinoma. The patient refused surgery owing to his age and significant co-morbidities. Another ERCP with intraductal cholangioscopic (SpyGlass) observation was arranged. Some mucosal erosions and nodular hyperplasia were found endoscopically ([Fig. 2]). A circumferential irradiation fiber was introduced through the channel of the endoscope ([Fig. 3]) and connected to a laser system (Leonardo, 1470 nm and 980 nm dual wavelength; CeramOpteec GmbH of Biolitec AG, Bonn, Germany). Continuous ablation was carried out until all visualized tumors had been burned to a whitish and necrotic appearance, producing a wider lumen ([Fig. 4]), before a metal stent was placed ([Fig. 5]). The patient recovered unremarkably and was discharged 5 days later ([Video 1]).

Fig. 1 Magnetic resonance cholangiopancreatography image showing a stenosis of 2 cm in length in the common bile duct, with dilatation of the biliary system above.

Fig. 2 Intraductal cholangioscopic view showing some mucosal erosions and nodular hyperplasia in the common bile duct.

Fig. 3 Photograph of the laser fiber after its introduction through the channel of the intraductal cholangioscope.

Fig. 4 Intraductal cholangioscopic view showing the tumor tissues burned whitish and necrotic by laser ablation, with the wider lumen now apparent.

Fig. 5 Fluoroscopic view showing a metal stent that had been endoscopically placed across the biliary stricture.

Video 1 Laser ablation under intraductal cholangioscopic guidance is performed for a cholangiocarcinoma.

In recent decades, endoscopic radiofrequency ablation has been introduced into clinical use to palliate unresectable cholangiocarcinoma [1] [2]; however, it has not been possible to perform this technique under direct visualization. A preclinical study has been reported on laser ablation in the biliary system [3]. A few authors have also reported using intraductal cholangioscopy-guided laser dissection for benign pancreatic/biliary ductal strictures [4] [5]. To the best of our knowledge, this may be the first application of visualized ablation for cholangiocarcinoma using a dual-wavelength laser such as this. Our experience suggested good cutting and hemostatic effect for this novel technique, which may be promising in future applications.

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Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Yang J, Wang J, Zhou H. et al. Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial. Endoscopy 2018; 50: 751-760
• 2 Gao DJ, Yang JF, Ma SR. et al. Endoscopic radiofrequency ablation plus plastic stent placement versus stent placement alone for unresectable extrahepatic biliary cancer: A multicenter randomized controlled trial. Gastrointest Endosc 2021; 94: 91-100.e2
• 3 Saccomandi P, Quero G, Gassino R. et al. Laser ablation of the biliary tree: in vivo proof of concept as potential treatment of unresectable cholangiocarcinoma. Int J Hyperthermia 2018; 34: 1372-1380
• 4 Mittal C, Shah RJ. Pancreatoscopy-guided laser dissection and ablation for treatment of benign and neoplastic pancreatic disorders: an initial report (with videos). Gastrointest Endosc 2019; 89: 384-389
• 5 Han S, Shah RJ. Cholangiopancreatoscopy-guided laser dissection and ablation for pancreas and biliary strictures and neoplasia. Endosc Int Open 2020; 8: E1091-E1096

Publication History

Article published online:
30 March 2023