ENDOSCOPIC RADIOFREQUENCY ABLATION FOR PALLIATIVE TREATMENT OF HILAR CHOLANGIOCARCINOMA

A 58-years-old woman, with priors of Parkinson disease, type 2 Diabetes Mellitus and arterial hypertension, was diagnosed with a perihilar cholangiocarcinoma (Bismuth Type 1). She initially underwent endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology and stent placement in the right hepatic duct. She was proposed for resection surgery but due to imagiological evidence of portal vein and right hepatic artery invasion and disease progression with involvement of the right and left hepatic duct (Bismuth Type 4), after multidisciplinary discussion, she was proposed for palliative care. Due to progressive worsening jaundice and cholestasis, it was decided to repeat ERCP. After removal of the previously placed plastic stent, cholangioscopy (SpyGlass DS; Boston Scientific) was performed. This exam confirmed the presence of a hepatic confluence stenosis, with neovascularization and involvement of the right and left hepatic duct. The length of the stenosis was approximately 5 cm. Endobiliary radiofrequency ablation (RFA; Habib catheter, Boston Scientific) was performed on two levels, initially on a proximal level, for full-extent treatment of the lesion. Cholagioscopy was repeated for treatment evaluation and exclusion of complications. On the examination we observed an increase in the luminal diameter and apparent necrosis at the level of the lesion. An uncovered self-expandable metal stent (10 cm) was placed in the left hepatic duct. The procedure underwent without complications and the patient was discharged home. She was evaluated one month later in the outpatient clinic and is asymptomatic. Blood test revealed complete normalization of total bilirubin and cholestasis.

Some studies previously reported an improvement in stent patency and even survival after RFA of biliary tumors. This case highlights the role of this technique as a feasible and safe therapeutic option for the palliation of hilar cholangiocarcinoma.