The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endoscopic bipolar radiofrequency ablation for the treatment of malignant biliary obstructions from cholangiocarcinoma or pancreatic adenocarcinoma (IPG464) in September 2013. NICE is currently updating this guidance. The new guidance will be published shortly. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Process IP
Description Endoscopic radiofrequency ablation uses heat energy to ablate malignant tissue that is obstructing the bile or pancreatic ducts. This may be done before inserting stents or to clear obstructed stents. The procedure is done with the patient under sedation. Endoscopic retrograde cholangiopancreatography (ERCP) with fluoroscopic guidance is used to establish the length, diameter and position of the stricture. Under endoscopic visualisation, a bipolar endoscopic radiofrequency ablation catheter is deployed over a guide wire across the stricture. Controlled pulses of radiofrequency energy are applied to obstructing tumour tissue to ablate it and to allow insertion of a stent, or to clear the lumen of a previously placed stent. Sequential applications are applied throughout the length of the stricture in order to achieve recanalisation. Repeat treatments may be used if obstruction recurs.

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance