Korean J Gastroenterol.  2021 Oct;78(4):205-212. 10.4166/kjg.2021.121.

Recent Updates on Endoscopic Retrograde Cholangiography-guided Intraductal Radiofrequency Ablation for Malignant Biliary Stricture

• Cho JH
• Jang SI
• Do MY
• Lee DK

• KMID: 2521494
• DOI: http://doi.org/10.4166/kjg.2021.121

Abstract

Malignant biliary strictures are caused by pancreatobiliary cancer and other metastatic malignancies. Most of them are unresectable at diagnosis with a dismal prognosis. Various new ablation methods have been introduced. Of them, ERCP-guided intraductal radiofrequency ablation (ID-RFA) appears to be the most promising minimally invasive endoscopic treatment by delivering a high-frequency alternating current to the target tissue, leading to coagulative necrosis. Thus far, many studies have provided evidence that ERCP-guided ID-RFA is a safe, feasible, and effective treatment modality for stent patency and overall survival. Compared to other ablation treatments, ERCP-guided ID-RFA has several advantages, including ease of delivery, controlled application of thermal energy, low cost, and fewer systemic side effects with an acceptable safety profile. Therefore, ERCP-guided ID-RFA can be considered an adjunctive treatment for the palliation of unresectable malignant biliary strictures. On the other hand, the decision of local ablation treatment should be individualized by multidisciplinary team support due to the lack of comparative studies.

Keyword

Radiofrequency ablation; Cholangiopancreatography; endoscopic retrograde; Intraductal carcinoma; Biliary tract neoplasms; Jaundice

Figure

• 

  Fig. 1 Schematic diagram of endoscopic retrograde cholangiography-guided intraductal radiofrequency ablation. RFA, radiofrequency ablation; ELRA, endoluminal radiofrequency ablation.

• 

  Fig. 2 Endoscopic retrograde cholangiography (ERCP)-guided intraductal radiofrequency ablation (ID-RFA). (A) Cholangiogram showing intraductal filling defects in the common bile duct. (B) ERCP-guided ID-RFA (80℃, 10 W for 120 sec) was performed using the endoluminal radiofrequency ablation RFA catheter® (Starmed, Goyang, Korea). An endoscopic image showed the ablated tumor tissue after balloon retrieval. (D) At the end of the procedure, a biliary self-expanding metal stent was placed in the post-RFA stricture site after ID-RFA.

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