2 The condition, current treatments and procedure
2.1 Biliary obstruction caused by cancers such as cholangiocarcinoma or pancreatic adenocarcinoma causes symptoms including jaundice, nausea, bloating and abdominal pain. Surgical resection is often not possible.
2.2 Current management of unresectable cholangiocarcinoma or pancreatic cancer includes biliary stenting during endoscopic retrograde cholangiopancreatography, chemotherapy, biological therapies (for example, monoclonal antibodies), radiation therapy and photodynamic therapy, which involves using a light-sensitive drug and a light source to destroy abnormal cells. Stents often need to be replaced because of blockage by tumour ingrowth.
2.3 Endoscopic bipolar 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.
2.4 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 are applied to obstructing tumour tissue to ablate it, and to allow insertion of a stent or clear the lumen of a previously placed stent. Sequential applications are applied throughout the length of the stricture to achieve recanalisation. Repeat treatments may be used if obstruction recurs.