Clin Endosc.  2018 Mar;51(2):201-205. 10.5946/ce.2017.097.

Bile Duct Patency Maintained after Intraductal Radiofrequency Ablation in a Case of Hepatocellular Cholangiocarcinoma with Bile Duct Invasion

• Han SY
• Song GA
• Kim DU
• Baek DH
• Lee MW
• Kim GH

• KMID: 2410990
• DOI: http://doi.org/10.5946/ce.2017.097

Abstract

Combined hepatocellular-cholangiocarcinoma (HCC-CC) with bile duct invasion (BDI) is rare. In unresectable cases, biliary stent placement and photodynamic therapy (PDT) are used for resolving obstructive jaundice. However, stent occlusion remains problematic, and PDT is expensive and time-consuming. Intraductal radiofrequency ablation (RFA) is an emerging procedure for palliation in these patients. It has potential benefits including less expense, lower rates of severe complication, longer maintenance of ductal patency, and easier technique compared with PDT or stenting alone. We report a 67-year-old man who underwent repeated intraductal RFA for HCC-CC and HCC with BDI, for whom bile duct patency was maintained without additional biliary procedures.

Keyword

Carcinoma, hepatocellular; Intraductal ablation; Bile duct invasion

MeSH Terms

Aged
Bile Ducts*
Bile*
Carcinoma, Hepatocellular
Catheter Ablation*
Cholangiocarcinoma*
Humans
Jaundice, Obstructive
Photochemotherapy
Stents

Figure

• 

  Fig. 1. Computed tomography (CT) image. (A) An initial CT revealed a 6.6-cm main mass at S2/3 and a 2-cm intraductal mass at the left proximal intrahepatic bile duct. (B) A follow-up CT after 5 months revealed the disappearance of the left intrahepatic ductal dilatation after the first intraductal radiofrequency ablation (RFA) procedure and the sixth cycle of chemotherapy. (C) The next follow-up CT after 7 months revealed a recurrent intraductal mass with dilatation of the left intrahepatic bile duct. (D) A follow-up CT after 9 months revealed that the left intrahepatic bile duct dilatation was improved after repeated intraductal RFA.

• 

  Fig. 2. Endoscopic retrograde cholangiopancreatography (ERCP). (A) ERCP demonstrated left intrahepatic duct obstruction due to the suspicion of an intraductal mass . (B) Intraductal radiofrequency ablation (RFA) was performed at the left proximal intrahepatic duct. (C) The necrotic tissue was removed after intraductal RFA (arrow: necrotic tissue).

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