Recanalization of obstructed metallic uncovered biliary stent using endobiliary radiofrequency ablation

Abstract

We present the case of a 57-year-old woman with a history of hilar cholangiocarcinoma type 3A of the Bismuth classification. A right hepatectomy after right portal embolization was planned. Finally, because peritoneal carcinomatosis was diagnosed during surgery, a palliative strategy was decided. Two uncovered metallic biliary stents (left and right hepatic ducts) were placed, and chemotherapy was started. Four months later, percutaneous placement of another metallic stent was necessary because of stent occlusion. Four months later, she was readmitted because of acute cholangitis resulting from stent re-occlusion. We used radiofrequency ablation for its recanalization (Video 1, available online at www.giejournal.org). After ERCP confirmed tumor ingrowth into the stent (Fig. 1A), a endobiliary radiofrequency ablation (RFA) catheter (Habib, EndoHPB, EMCision, London, UK) was inserted through the endoscope on a 0.035-inch guidewire. The distal tip of the catheter with the 2 electrodes was advanced through the stenosis under fluoroscopic guidance. Two RFA applications were performed (bipolar coagulation mode, maximum 10 W, 90 seconds). Necrotic debris was extracted by use of a balloon catheter. Stent clearance was confirmed by cholangiography (Fig. 1B) and tomography. Chemotherapy was resumed, and no further obstruction of the stent occurred during the following 6 months. Unfortunately, during follow-up, the patient died, but not of a biliary adverse event. This case illustrates the potential benefit and ease of use of endobiliary RFA for stent recanalization. Nevertheless, a cost-effectiveness analysis is warranted.