Radiofrequency ablation for the treatment of biliary strictures due to cholangiocarcinoma through ERCP in a neoadjuvant approach.

Neil Sharma, MD
Director of Advanced Interventional Endoscopy & Endoscopic Oncology Chief of Endoscopy
Medical Director of GI Oncology Program
President Parkview Cancer Institute, Fort Wayne, Indiana

Mariajose Rojas-DeLeon, MD
Director of Heptocellular Carcinoma (HCC) program for PCI
Director of Interventional Endohepatology subprogram for IOSE
Interventional endoscopist with IOSE
Parkview Regional Medical Center, Fort Wayne, Indiana

Patient History

Procedure

An ERCP was performed, occlusion cholangiogram showed a stricture due to cholangiocarcinoma (Figure 1) involving the common hepatic duct, and part of the right common intrahepatic duct.  Cholangioscopy was then performed, using the DS II system.  Images revealed a malignant stricture secondary to the tumor at the common hepatic duct, with extension into the right common intrahepatic duct, it also revealed stent tumor ingrowth (Fig 2).  The SpyGlass cholangioscope was then exchanged over a wire to the Habib RFA catheter, this was then advanced to the appropriate position, confirmed by fluoroscopy (Figure 3). The first ablation was done with effect 8 at 7 watts for 90 seconds since the area was intrahepatic.  After one-minute cool down period, the catheter was repositioned at the level of the common hepatic duct, in the extrahepatic area, and the second ablation was done with effect 8 at 10 Watts for 90 seconds, after a one-minute cool down, we repeated the cholangioscopy to evaluate the post ablated are, which showed a charred appearance of the biliary mucosa, additionally it showed black specks which correlate to ablated blood vessels. These findings confirmed that the area was adequately ablated (Fig 4). A plastic stent was then placed after ablation.