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CC BY 4.0 · Endoscopy 2025; 57(S 01): E1157-E1158
DOI: 10.1055/a-2717-1332
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Endoluminal radiofrequency ablation for ingrowth occlusion after endoscopic ultrasound-guided hepaticogastrostomy with bridging stent placement

Authors

  • Kenjiro Yamamoto

    1   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

  • Takayoshi Tsuchiya 

    1   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

  • Ryosuke Tonozuka 

    1   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

  • Shuntaro Mukai 

    1   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

  • Hiroyuki Kojima

    1   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

  • Noriyuki Hirakawa 

    1   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

  • Takao Itoi

    1   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Endoscopic ultrasound-guided hepaticogastrostomy with bridging stent placement is a useful drainage option when endoscopic retrograde cholangiopancreatography fails for reasons such as inaccessible papillae or surgical anastomosis, particularly in patients with malignant hilar biliary obstruction who require bilateral drainage [1] [2]. Recent advances in chemotherapy, such as targeted drugs for specific gene mutations, have improved prognosis in biliary tract cancers [3]. Therefore, the management of recurrent biliary obstruction after stent placement is also an important issue. Endoluminal radiofrequency ablation (RFA) is a novel procedure for biliary diseases and may be an option for treating ingrowth occlusion after metal stent deployment [4] [5].

An 80-year-old man was admitted with obstructive jaundice during chemotherapy for local relapse after Whipple surgery for cholangiocarcinoma. He had previously undergone right hepatic drainage with bridging metal stent placement through the hepaticogastrostomy route. Contrast-enhanced computed tomography demonstrated dilatation of the anterior bile duct ([Fig. 1]). Cholangiography and peroral cholangioscopy (POCS) revealed stent occlusion due to tumor ingrowth ([Fig. 2]). Additional stent placement through previously inserted bilateral metal stents was considered technically challenging. Thus, RFA was performed with a temperature-controlled RF catheter (ELRA; StarMed Co., Goyang, Korea). The RF generator (VIVA Combo; StarMed Co.) was set to a maximum temperature of 80°C and power of 7W for a 2-min duration and was then connected to an 18-mm RF catheter. Ablation was performed stepwise, spanning the stricture ([Fig. 3]). After RFA, a temporary endoscopic nasobiliary drainage tube was placed. Four days after RFA, cholangiography and POCS confirmed ablation of the ingrowth regions and recanalization of the stent lumen ([Fig. 4]; [Video 1]). The patient was discharged after plastic stent placement through the hepaticogastrostomy route. Recanalization using RFA was clinically successful, with no recurrence of biliary obstruction for more than 3 months.

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Fig. 1 Contrast-enhanced computed tomography showing dilatation of the anterior bile duct (asterisk). For local relapse after Whipple surgery for cholangiocarcinoma, right hepatic drainage with bridging metal stent placement through the hepaticogastrostomy route had previously been performed and another metal stent placed from the jejunum to the left hepatic duct in a stent-in-stent configuration (arrow). A plastic stent had been placed across the hepaticogastrostomy route (arrowhead).
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Fig. 2 Stent occlusion due to tumor ingrowth: a cholangiographic view; b peroral cholangioscopic view.
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Fig. 3 Stepwise endoluminal radiofrequency ablation spanning the stricture: fluoroscopic view.
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Fig. 4 Successful ablation of the ingrowth regions and recanalization of the stent lumen: a cholangiographic view; b peroral cholangioscopy.
Radiofrequency ablation for ingrowth occlusion after endoscopic ultrasound-guided hepaticogastrostomy with bridging stent placement.Video 1

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Conflict of Interest

T. Itoi is a consultant for Olympus, Boston Scientific Japan, and Gadelius Medical K.K. T. Tsuchiya is a consultant for Olympus and Boston Scientific Japan. K. Yamamoto, R. Tonozuka, S. Mukai, H. Kojima, and N. Hirakawa state that they have no conflicts of interest to declare.


Correspondence

Takao Itoi, FJGES, FASGE
Department of Gastroenterology and Hepatology, Tokyo Medical University
6-7-1 Nishishinjuku, Shinjuku-ku
Tokyo 160-0023
Japan   

Publication History

Article published online:
21 October 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/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany


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Zoom
Fig. 1 Contrast-enhanced computed tomography showing dilatation of the anterior bile duct (asterisk). For local relapse after Whipple surgery for cholangiocarcinoma, right hepatic drainage with bridging metal stent placement through the hepaticogastrostomy route had previously been performed and another metal stent placed from the jejunum to the left hepatic duct in a stent-in-stent configuration (arrow). A plastic stent had been placed across the hepaticogastrostomy route (arrowhead).
Zoom
Fig. 2 Stent occlusion due to tumor ingrowth: a cholangiographic view; b peroral cholangioscopic view.
Zoom
Fig. 3 Stepwise endoluminal radiofrequency ablation spanning the stricture: fluoroscopic view.
Zoom
Fig. 4 Successful ablation of the ingrowth regions and recanalization of the stent lumen: a cholangiographic view; b peroral cholangioscopy.