3 The procedure
3.1 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.
3.2 The procedure is done with the patient under sedation. Endoscopic retrograde cholangiopancreatography 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 delivered by a radiofrequency generator 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.