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Create a Free AccountAnatomy - Hepatopancreatobiliary
The interventional direct peroral cholangioscopy toolbox for endoscopic snare resection of a high-grade biliary intraductal neoplasia
Direct peroral cholangioscopy (DPOC) is a valuable diagnostic and therapeutic tool for various biliary disorders because it allows direct endoscopic visualization of biliary lumen and mucosal abnormalities. Direct cholangioscopy carries several benefits, including high-definition imaging with the availability of narrow-band imaging, lower operating expenses and cost, and the ability to use a wide range of accessories through the working channel.1,2 In this article, we demonstrate endoscopic techniques for performing biliary intraductal polypectomy using the ultra-slim pediatric gastroscope (GIF-H190N; Olympus America, Center Valley, Pa) and showcase the various endoscopic accessories available for use.Photodynamic therapy for hepatic hilar intraductal papillary neoplasm of the bile duct: a case report
Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease that is characterized by papillary or villous neoplasm within the lumen of the bile duct.1 IPNB can develop anywhere along the biliary tree.2 In principle, aggressive resection is recommended as the first choice. However, hepatectomy is too aggressive for small localized tumors without significant invasion. Here, we report a case of a small hilar IPNB that was diagnosed using a digital cholangioscope (SpyGlass, Boston Scientific, Marlborough, Mass) and treated by cholangioscopy-guided photodynamic therapy (PDT) (Guoyi Huake, Suzhou, China).Novel EUS-guided microwave ablation of an unresectable pancreatic neuroendocrine tumor
Pancreatic neuroendocrine tumors have an incidence of ≤1 case per 100,000 individuals, accounting for up to 2% of all pancreatic neoplasms in the United States. The 5-year overall survival rate ranges from 37.6% to 50%.1 Curative surgical interventions are not feasible for most patients because most cases are detected in advanced unresectable stages, mainly in elderly patients with several comorbidities.2 Therefore, developing safe and effective alternatives for patients unfit for surgery is imperative for clinical practice.Electrohydraulic lithotripsy under the mother-baby cholangioscope system using a colonoscope for large common bile duct stones in a patient with Roux-en-Y reconstruction
Electrohydraulic lithotripsy (EHL) is useful for the treatment of common bile duct (CBD) stones (CBDSs) when stones are larger than 2 cm in diameter or conventional extraction methods have proven ineffective.1 However, EHL requires direct visualization of the CBD, which is often challenging in patients who have undergone Roux-en-Y reconstruction. There have been some reports of EHL under direct cholangioscopy using an enteroscope or ultra-slim upper endoscope for patients with a history of Roux-en-Y reconstruction.Endoscopic radiofrequency ablation for palliative treatment of hilar cholangiocarcinoma
Recent data support a role for endoscopic radiofrequency ablation (RFA) in unresectable cholangiocarcinoma by improving stent patency and overall survival.Complex endoscopic management of gallbladder cancer patient with Bouveret syndrome
A 59-year-old white woman with unresectable metastatic adenocarcinoma of the gallbladder and a malignant hilar stricture managed with palliative uncovered metal stents in a Y-shaped configuration and repeated radiofrequency ablation (RFA) for tumor ingrowth was incidentally found to have duodenal obstruction caused by a large stone precluding a scheduled session of RFA. Because she had no complaints or symptoms related to the presence of the stone, a decision was made to abort the procedure and proceed with further assessment.Immediate and durable therapeutic response after EUS-guided radiofrequency ablation of a pancreatic insulinoma
EUS-guided radiofrequency ablation (RFA) is an endoscopic procedure and emerging therapeutic option for the treatment of pancreatic tumors.1-3 It has been described in recent years for local therapy of pancreatic adenocarcinoma and neuroendocrine tumors in patients for whom operative management is deemed unsuitable.1,4,5 Hyperthermic ablation using radiofrequency waves at 500 kHz is used to induce irreversible cellular injury and necrosis of the target lesion.6,7 Precise delivery of thermal energy is critical to spare the normal surrounding pancreatic tissue from injury.Endoscopic treatment of symptomatic insulinoma with a new EUS-guided radiofrequency ablation device
Functional neuroendocrine tumors (NETs) of the GI tract are characterized by hormone secretion resulting in a specific clinical syndrome.1 With insulinomas, one of the most common types of pancreatic NET (pNETs), hypoglycemia can be profound and debilitating.1,2 Surgical resection has been the longstanding treatment, but in patients unfit for or unwilling to undergo surgery, a nonoperative approach with EUS-guided radiofrequency ablation (EUS-RFA) has been described as an alternative to restoring euglycemia.EUS-guided celiac plexus radiofrequency ablation using a novel device
The incidence of pancreatic cancer in the U.S. population was estimated to be 53,670 in 2017.1 Abdominal pain is common in patients with pancreatic cancer and can be intense, debilitating, and refractory to medical treatment.2 EUS celiac plexus neurolysis (CPN) is considered efficacious in the management of pancreatic cancer pain and can be used early at the time of diagnosis of inoperable disease.3EUS-guided radiofrequency ablation of a pancreatic neuroendocrine tumor
Although radiofrequency ablation (RFA) has been well described in the treatment of Barrett’s esophagus with dysplasia by inducing local thermal necrosis, its role through the use of EUS has garnered considerable interest over the past few years, particularly with pancreatic cysts and tumors. Although surgery remains the mainstay for solid pancreatic neoplasms, EUS-guided RFA offers a safe and effective treatment option in patients deemed unfit for, or who do not wish to undergo, surgery.1-4 Here, we present a case of an 82-year-old woman with osteoarthritis who presented with progressively worsening upper-abdominal pain over the past month and accompanying weight loss.EUS-guided radiofrequency ablation for a left adrenal oligometastasis of an esophageal adenocarcinoma
A 65-year-old man was referred for treatment of a poorly differentiated Her2-negative adenocarcinoma of the distal esophagus. Staging, according to the guidelines of the European Society of Digestive Oncology (ESMO) for esophageal cancer,1 showed locoregional lymph nodes and was suspicious for a solitary metastasis in the left adrenal gland (T3N1M1) (Fig. 1).Successful use of radiofrequency ablation for the management of a recurrent ampullary adenoma with intraductal extension
We present a case in which radiofrequency ablation (RFA) was used for the treatment of an ampullary adenoma with persistent intraductal growth despite prior treatments with endoscopic ampullectomy and argon plasma coagulation (APC). Cholangioscopy was used to evaluate the full extent of intraductal tissue. RFA was applied over 2 sessions (7-10 watts) for 90 seconds with the achievement of successful ablation (Video 1, available online at www.VideoGIE.org ). There was no endoscopic or histologic evidence of adenoma recurrence at a 6-month surveillance visit.Cholangioscopic appearance after radiofrequency ablation of cholangiocarcinoma
An estimated 39,000 cases of cholangiocarcinoma (CC) were diagnosed in the United States in 2016.1 Of the patients with diagnoses of CC, two-thirds are unable to undergo surgical resection and require locoregional therapy.2,3 Given the ever-rising prevalence of this condition and the intimate involvement of the advanced endoscopist in the care of these patients, intraductal therapies have arisen, which may serve an important role in the care of CC.
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