Endoscopy 2018; 50(04): S45
DOI: 10.1055/s-0038-1637162
ESGE Days 2018 oral presentations
20.04.2018 – ERCP 2: bile duct stenosis
Georg Thieme Verlag KG Stuttgart · New York

RADIOFREQUENCY ABLATION (RFA) FOR INTRABILIARY EXTENSION OF ADENOMA OF THE PAPILLA OF VATER: PRELIMINARY RESULTS

A Tringali
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
V Bove
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
I Boškoski
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
G Valerii
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
R Landi
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
B Federico
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
P Familiari
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
V Perri
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
,
G Costamagna
1   Catholic University of Rome, Digestive Endoscopy Unit, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Endoscopic papillectomy of adenoma of the papilla of Vater is an effective technique which can be curative in more than 85% of the cases. Intrabiliary extension of the adenoma can limit the curative intent of the endoscopic resection. Radiofrequency ablation (RFA) of the intraductal extension was evaluated in consecutive patients with adenoma of the papilla of Vater after papillectomy.

Methods:

Endoscopic papillectomy was performed with an intent for en-bloc-resection without submucosal injection and placement of a 5 french prophylactic pancreatic stent. Possible intra-biliary extension was assessed on cholangiogram and after traction with an inflated extraction balloon: biopsies were performed and a biliary stent was placed. RFA was performed with the VIVAcomboTM generator (STARmed, South Korea) and an 18 or 33 mm long bipolar catheter (ELRA), power setting 10W-80 °-2 minutes.

Results:

Between March-2016 and October-2017, 4 patients (3F, mean age 64-years) underwent endoscopic papillectomy for adenoma of the papilla of Vater (3 low 1 high-grade dysplasia on pre-operative histology) with intrabiliary extension. Liver function tests were normal in all the cases. Final histology resulted in LGD (n = 2), HGD (n = 1) and HGD with adenocarcinoma (n = 1, the patient refused surgery). Intrabiliary biopsies showed LGD (n = 3) and HGD (n = 1). RFA was performed during ERCP one month later (3 cases with a pancreatic stent in place, 1 without due to failure in replacement). The patient without the pancreatic stent developed severe post-RFA pancreatitis which resolved with conservative treatment. After a follow-up of 1, 5, 19 and 20 months (mean 11.2) 3 patients have no evidence of residual intrabiliary adenoma on biopsies, while the patient with adenocarcinoma accepted surgery.

Conclusions:

RFA ablation of intrabiliary extension of adenoma after papillectomy appears feasible and effective. According to our small experience, RFA should be performed with a pancreatic stent in place to reduce the risk of pancreatitis. Further data and extended follow-up are needed.