scholarly journals Percutaneous endobiliary radiofrequency ablation for tumor ingrowth causing metal stent obstruction

2020 ◽  
Vol 32 (6) ◽  
Author(s):  
Jun Seong Hwang ◽  
Hoonsub So ◽  
Tae Jun Song
Keyword(s):  
Radiofrequency Ablation ◽  
Metal Stent ◽  
Tumor Ingrowth

scholarly journals Feasibility and Safety of Endoluminal Radiofrequency Ablation as a Rescue Treatment for Bilateral Metal Stent Obstruction Due to Tumor Ingrowth in the Hilum: A Pilot Study

2021 ◽  
Vol 10 (5) ◽  
pp. 952
Author(s):  
Hoonsub So ◽  
Chi Hyuk Oh ◽  
Tae Jun Song ◽  
Hyun Woo Lee ◽  
Jun Seong Hwang ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Bile Duct ◽  
Adverse Events ◽  
Bile Duct Obstruction ◽  
Metal Stents ◽  
Metal Stent ◽  
Duct Obstruction ◽  
Tumor Ingrowth ◽  
Malignant Bile Duct Obstruction ◽  
Hilar Bile Duct

Background. Radiofrequency ablation (RFA) is a palliative method known for its application in the endoscopic treatment of malignant bile duct obstruction. It may be a useful rescue method for metal stent malfunction caused by tumor ingrowth. This study aimed to examine the feasibility and safety of endoluminal RFA for occluded bilateral hilar metal stents due to tumor ingrowth in patients with malignant hilar bile duct obstruction. Methods: From March 2016 to June 2018, 11 patients with unresectable malignant hilar bile duct stricture with occluded bilateral hilar metal stents due to tumor ingrowth were enrolled. Endoluminal RFA was performed through a novel temperature-controlled catheter at a setting of 7 W power for 120 s with a target temperature of 80 °C via endoscopic retrograde cholangiopancreatography (ERCP). The patients’ demographics, clinical outcomes, and adverse events were investigated. Results: The median age was 64 (interquartile range, 54–72) years. All RFA procedures were successful. Clinical success was achieved in eight patients (72.7%). During the follow-up, eight patients (72.7%) showed stent dysfunction, and the median patency after RFA was 50 days (95% confidence interval (CI): 34–not available (NA)). All stent dysfunctions were successfully managed with ERCP. Ten patients died, and the median overall survival was 289 days (95% CI, 107–NA) from RFA to death. There was one case of mild abdominal pain after the procedure without serious adverse events. Conclusions: As a rescue therapy for occluded bilateral hilar metal stents due to tumor ingrowth, endoluminal RFA seemed to be safe and useful in selected patients.

scholarly journals Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction

2017 ◽  
Vol 05 (12) ◽  
pp. E1211-E1217 ◽  
Author(s):  
Katsuya Kitamura ◽  
Akira Yamamiya ◽  
Yu Ishii ◽  
Yuta Mitsui ◽  
Tomohiro Nomoto ◽  
...  
Keyword(s):  
Stent Placement ◽  
Biliary Obstruction ◽  
Success Rates ◽  
Metal Stent ◽  
Stent Removal ◽  
Tumor Ingrowth ◽  
Hilar Biliary Obstruction ◽  
Malignant Hilar Biliary Obstruction ◽  
Self Expandable Metal Stent

Abstract Background and study aims This study investigated the feasibility of side-by-side (SBS) partially covered self-expandable metal stent (PCSEMS) placement for unresectable malignant hilar biliary obstruction (MHBO). Patients and methods We retrospectively analyzed 33 patients from a single center who underwent endoscopic biliary drainage for unresectable MHBO from July 2013 to June 2015. In all patients with bilateral obstruction during complete bilateral intrahepatic cholangiograms, we performed endoscopic SBS placement of a 6-mm diameter PCSEMS using an 8-French delivery system. All patients underwent endoscopic sphincterotomy. Generally, patients with recurrent biliary obstruction (RBO) after stent placement underwent endoscopic reintervention. Our study outcomes included the technical and functional success rates, RBO rate, time to RBO (TRBO), reintervention rate, and incidence of adverse events. Results Seventeen patients with unresectable MHBO during complete bilateral intrahepatic cholangiograms underwent endoscopic SBS PCSEMS placement (median age, 78 years; men, 9). Lesions were Bismuth types II (n = 10), III (n = 1), and IV (n = 6), including 10 cholangiocarcinomas, 3 gallbladder cancers, and 4 metastatic cancers. In all patients, the PCSEMS was placed across the duodenal papilla. The technical and functional success rates were 100 % and 82 %, respectively. The median procedure time was 43 minutes (interquartile range [IQR]: 36 – 52 minutes). Twelve patients had RBO (71 %), including 9 stent occlusions due to sludge and 3 stent migrations. The median TRBO was 79 days (IQR: 58 – 156 days) during the follow-up period (median 192 days [IQR: 88 – 551 days]). The median TRBO of patients with Bismuth type II lesions was significantly longer than that of patients with Bismuth types III and IV lesions (87 days [IQR: 70 – 244 days] vs. 54 days [IQR: 35 – 100 days]; P  = 0.030). Thirteen patients (76 %) required endoscopic reintervention. Endoscopic stent removal was possible in 6 patients without tumor ingrowth into the uncovered distal part of the stent. One late adverse event (≥ 31 days) occurred (cholangitis). Conclusions Endoscopic SBS placement of a PCSEMS was feasible in patients with unresectable MHBO. Additionally, reinterventional stent removal was possible in the absence of tumor ingrowth.

Broken biliary metal stent after repeated electrocoagulation for tumor ingrowth

1992 ◽  
Vol 38 (2) ◽  
pp. 197-198 ◽  
Author(s):  
Christian Ell ◽  
Wolfgang E. Fleig ◽  
Jürgen Hochberger
Keyword(s):  
Metal Stent ◽  
Tumor Ingrowth ◽  
Biliary Metal Stent

scholarly journals SpyGlass DS -Directed Radiofrequency Ablation with Double Biliary Metal Stent Placement for Managing Recurrent Obstructive Jaundice Secondary to Castleman Disease: A Case Report of a Rare Disease (with Videos)

2020 ◽  
Author(s):  
Lijia Wen ◽  
Junhong Chen ◽  
Liang Guo ◽  
Kai Liu
Keyword(s):  
Radiofrequency Ablation ◽  
Obstructive Jaundice ◽  
Abdominal Mass ◽  
Castleman Disease ◽  
Metal Stent ◽  
Stent Patency ◽  
Stent Occlusion ◽  
Upper Abdominal ◽  
Spyglass Ds ◽  
Biliary Metal Stent

Castleman disease (CD) rarely presents with obstructive jaundice, which poses a diagnostic and therapeutic challenge to the management of the disease. A 40-year-old man was referred to our hospital for emergent management of upper abdominal pain. An abdominal mass was removed, and the postoperative pathology showed retroperitoneum CD, which was subsequently managed by adjuvant therapy of combination chemotherapy and steroids. One month later, a biliary metal stent was placed due to the presentation of obstructive jaundice. After approximately 3 months, the patient experienced another episode of obstructive jaundice, and SpyGlass DS cholangioscopy (Boston Scientific, Natick, Mass, USA) was performed via the biliary track for biopsy, which pathologically showed biliary malignancies. Radiofrequency ablation was performed with a probe (EMcision, Montreal, Canada), and another uncovered metal stent was placed within the existing metal stent. No stent occlusion occurred during a 6-month follow-up period. In conclusion, CD rarely presents with obstructive jaundice, and a combination of radiofrequency ablation with metal stent implantation under cholangioscopy can prolong the stent patency time and the survival time of patients.

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