Endoscopic bipolar radiofrequency ablation for malignant biliary obstruction

Biliary obstruction caused by cancers such as cholangiocarcinoma or pancreatic adenocarcinoma can lead to symptoms such as jaundice, nausea, bloating and abdominal pain. Surgical resection is often not possible.

Treatment of unresectable cholangiocarcinoma or pancreatic cancer includes biliary stenting during endoscopic retrograde cholangiopancreatography, chemotherapy, radiation therapy, chemoradiation therapy, immunotherapy and photodynamic therapy. Stents often need to be replaced because of blockage by tumour ingrowth.

Endoscopic bipolar radiofrequency ablation (RFA) uses heat energy to ablate malignant tissue that is obstructing the bile or pancreatic ducts. This procedure is usually done before inserting stents (primary RFA), but can also be done to clear obstructed stents (secondary RFA). The aim is to prolong stent patency, so reducing symptoms and improving survival.

The procedure is usually done under sedation. Endoscopic retrograde cholangiopancreatography with fluoroscopic guidance is used to establish the length, diameter and position of the biliary stricture. Under endoscopic visualisation, a bipolar endoscopic RFA catheter is deployed over a guide wire across the stricture. Controlled pulses of radiofrequency energy are applied to ablate the obstructing tumour tissue to allow stent insertion or to clear the lumen of a previously placed stent. Sequential applications are usually applied throughout the length of the stricture to achieve recanalisation. The treatment can be repeated.