Digital single-operator cholangioscopy-guided endoluminal radiofrequency of an intraductal papillary mucinous neoplasia of the bile duct

Abstract

A 77-year-old man with recurrent episodes of abdominal pain was diagnosed with a difficult common bile stone by computed tomography (Fig. 1A). Endoscopic retrograde cholangiopancreatography and digital single-operator cholangioscopy (DSOC) with electrohydraulic lithotripsy cleared the bile duct stones and a small number of papillary neoplasms located at the hilar bile ducts were found incidentally (Fig. 1D). Tissues were collected under direct visualization with biopsy forceps and pathological examination revealed intraductal papillary mucinous neoplasia of the bile duct (IPNB). A novel radiofrequency operation electrode was inserted into the bile duct through DSOC (Fig. 1B). DSOC-guided endoluminal radiofrequency ablation (RFA) was used to destroy the lesions under direct vision (Fig. 1C; Video S1). After RFA, these neoplasms became necrotic (Fig. 1E) and pathological examination revealed charring of the tissues after RFA. No adverse events occurred. Finally, the patient has remained in good health and we plan to continue long-term follow-up.

IPNB is a relatively rare tumor derived from the biliary epithelium and is known as one of the premalignant lesions in the biliary duct.¹ Previous studies have reported endoscopic RFA was one of the local treatment options.^{2, 3} However, traditional RFA is guided by fluoroscopic images and cannot destroy the lesions precisely. To our knowledge, this is the first report that a DSOC-guided endoluminal radiofrequency catheter was used to ablate IPNB. This novel technique could be an accurate and microinvasive treatment method for selected patients with bile duct-related disorders.

Authors declare no conflict of interest for this article.