Nicholas Ludvik, MD1, Manoj Kumar, MD2, Yazan Fahmawi, MD2, Meir Mizrahi, MD3
1University of South Alabama College of Medicine, Mobile, AL; 2University of South Alabama, Mobile, AL; 3University of South Alabama College of Medicine, Spanish Fort, AL
Introduction: Management of malignant biliary obstruction (MBO) is largely palliative yet critical to maximizing patients’ quality of life. Uncovered Self-expanding metal stents (SEMS) are widely used in that context. However, the uncovered nature of these stents allows tissue ingrowth and intraluminal obstruction requiring frequent endoscopic retrograde cholangiopancreatography (ERCP), mechanical cleaning with a balloon or a second stent insertion in stent-in-stent fashion. Radiofrequency ablation (RFA) is a new intraductal procedure to ablate the tissue ingrowth and improve the patency of biliary stents. Here we are discussing one such case.
Case Description/Methods: A 54-year-old male with pancreatic adenocarcinoma with numerous metastases status post ERCP with uncovered metal stent placement. He was referred with hyperbilirubinemia and concern for stent occlusion. Endoscopy reveled a severely narrowed and distorted duodenum. ERCP was planned. Due to heavy tissue ingrowth and sludge, guidewire had to be placed under cholangioscopic guidance. A RFA catheter with 8 F bipolar probe and two ring electrodes (8mm long and 6mm apart) with ablation length of 25mm ± 3mm was advanced over guidewire under fluoroscopy. Intraductal RFA of the tissue ingrowth with in the stent was delivered with bipolar soft mode effect of 8-10 watts over 3 cycles. Post-ablation balloon sweeps produced large amounts of debris. A stricture noticed prior to RFA was seen again but with improved caliber. A fully covered 10mm x 80mm SEMS was placed across stricture. No procedure related complication was reported and patient continued with his chemotherapy
Discussion: Use of RFA in conjunction with SEMS placement appears promising. RFA appears to delay tumor ingrowth, thereby decreasing need for repeat intervention. Furthermore, a recent clinical trial demonstrated that this can prolong not only stent patency but also improves survival. This case emphasizes the increased applicability of RFA not only in gastrointestinal tract but also in biliary disease.
Citation: Nicholas Ludvik, MD; Manoj Kumar, MD; Yazan Fahmawi, MD; Meir Mizrahi, MD. P1009 - FIRE IN THE HOLE! ROLE OF RADIOFREQUENCY ABLATION FOR BILIARY STENT OCCLUSION: PROLONGING THE STENT PATENCY. Program No. P1009. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.