Login to your account
Don’t have an account?
Create a Free AccountProcedures - Ablation
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).Pancreatoscopy-guided laser dissection of obstructing pancreatic duct stricture: pancreas-preserving endotherapy
Pancreatic duct (PD) stones and strictures remain challenging sequelae of chronic calcific pancreatitis and contribute to ductal hypertension, which may manifest as abdominal pain, exocrine pancreatic insufficiency, or biliary obstruction.1,2 Standard ERCP techniques may be insufficient for complex lesions such as severe stricture(s) or extensive stone burden, whereby the degree of obstruction or ductal tortuosity may not permit passage of the wire or catheter.3 Peroral pancreatoscopy (POP) promotes direct ductal visualization and use of additional devices to treat such advanced pathology, which includes laser therapy that can be used for stone fragmentation or tissue dissection as a means of stricturoplasty.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.EUS-guided ethanol ablation of metastatic functional insulinoma
Pancreatic neuroendocrine tumors (NETs) are rare, representing only 1% of all pancreatic tumors.1 Pancreatic NETs are classified as functional or nonfunctional depending on the presence or absence of a clinical, hormonal hypersecretion syndrome. The clinical management of these lesions is challenging.Hybrid argon plasma coagulation for Barrett’s esophagus
As the incidence of esophageal adenocarcinoma increases in the United States, detection, diagnosis, and treatment for Barrett’s esophagus (BE) is even more critical.1 BE-related neoplasia is managed by endoscopic eradication therapy, a strategy of endoscopic resection of any nodular or visible lesion and ablation for flat neoplasia.2 Ablative modalities include radiofrequency ablation (RFA), argon plasma coagulation (APC), and cryoablation with either spray liquid nitrogen or balloon-based nitrous oxide therapy.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.Liquid nitrogen spray cryotherapy for intramucosal carcinoma and extensive gastric intestinal metaplasia with dysplasia
Gastric intestinal metaplasia with dysplasia (GIM-D) that is visible as a discrete limited lesion on endoscopy is readily treated using endoscopic mucosal resection or endoscopic submucosal dissection. However, there are few options for more extensive and invisible dysplasia. Ablating a wide swath of tissue with argon plasma coagulation or radiofrequency ablation can be challenging and carries risks, including postprocedure ulceration. Liquid nitrogen spray cryotherapy is an established treatment for dysplasia in Barrett’s esophagus, but its use for GIM-D has not been previously reported.Salvage circumferential endoscopic submucosal dissection for refractory dysplastic Barrett’s esophagus
A 64-year-old woman initially underwent endoscopy for reflux symptoms and was found to have C7M8 Barrett’s esophagus with biopsies demonstrating high-grade dysplasia. She was referred to a tertiary esophageal center, which performed endoscopic mucosa resection.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 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.Wire-guided and endoscopic-guided transesophageal echocardiographic probe insertion
Zenker's diverticulum (ZD) is the posterior pulsion diverticulum below the esophageal introitus through or above the cricopharyngeal muscle, and it is associated with a prominent cricopharyngeal bar.1,2 ZD can cause dysphagia, regurgitation of undigested food, cough, and aspiration of food particles. During endoscopy, ZD often creates difficulty in esophageal intubation. Flexible endoscopic treatment for ZD focuses on releasing the cricopharyngeal spasm by performing diverticulotomy on the septum.Multicenter case series of patients with small-bowel angiodysplasias treated with a small-bowel radiofrequency ablation catheter
GI angiodysplasia is the most common cause of small-bowel bleeding. Argon plasma coagulation (APC) is preferred for ablation because of its availability, ease of use, and perceived safety, but it has limitations. An instrument capable of repeated use through the enteroscope, which covers more area of intestinal mucosa per treatment with low risk of damage to healthy mucosa, and which improves ablation, is desirable. A series of patients treated with a through-the-scope radiofrequency ablation (RFA) catheter is reported.Novel EUS-guided brachytherapy treatment of pancreatic cancer with phosphorus-32 microparticles: first United States experience
Pancreatic adenocarcinoma is one of the most lethal and therapeutically resistant malignancies.1 There is no uniform consensus regarding standard of care for treatment of unresectable, locally advanced pancreatic cancer (LAPC). Treatment options include chemotherapy alone, chemotherapy followed by chemoradiotherapy, or stereotactic body radiation therapy.2,3Hybrid argon plasma coagulation: a new modality for treatment of a diffuse foregut anastomotic dysplastic lesion
Endoscopic management of a diffusely spreading adenomatous/dysplastic lesion at the site of a gastrojejunostomy (GJ) anastomosis can be challenging. EMR and endoscopic submucosal dissection (ESD) are technically difficult at such locations, and there is a risk of incomplete resection. We present a case of endoscopic management of such a lesion in an elderly patient using the novel hybrid argon plasma coagulation (APC) technology (Video 1, available online at www.VideoGIE.org ).Cholangioscopy-directed radiofrequency ablation of complex biliary cholangiocarcinoma
A 64-year-old woman underwent a segment 5/6 liver resection in February 2016 for cholangiocarcinoma. Chemotherapy was poorly tolerated and, therefore, was stopped in August 2016.Holmium laser vaporization and percutaneous removal of a migrated endothelialized biliary self-expanding metal stent
Self-expanding metal stents (SEMSs) are widely used for drainage of malignant biliary obstruction.1 Tissue ingrowth or overgrowth in uncovered SEMSs is common, and endoscopic removal is challenging. Holmium laser is the clinical criterion standard for endourologic lithotripsy because of its ability to fragment stones of a wide variety of compositions.2 Few studies have reported its use in the vaporization of exogenous prosthetic material in extraurinary scenarios. We report our experience using a Holmium laser for vaporization and percutaneous extraction of a partially endothelialized biliary SEMS causing recurrent obstruction and cholangitis.Pancreatic necrosectomy using an automated mechanical endoscopic tissue extraction device
A 66-year-old man with uncontrolled diabetes mellitus and prior cholecystectomy presented to an outside hospital with symptoms of intractable abdominal pain, nausea, and vomiting. He received a diagnosis of acute pancreatitis and was treated conservatively and eventually discharged. He continued to have persistent symptoms and was admitted again. An abdominal CT scan revealed a pancreatic fluid collection (PFC) with evidence of solid debris. The patient was transferred to our facility for further evaluation and treatment.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).EUS-guided radiofrequency ablation of a hepatocellular carcinoma of the liver
Percutaneous and intraoperative radiofrequency ablations (RFA) of hepatocellular carcinoma (HCC) are widely used treatment methods. EUS-guided RFA has recently been used for pancreatic tumors, whereas, to our knowledge, there are no reports of EUS-guided RFA for HCC. We present the case of a 75-year-old man with hepatitis C virus–related cirrhosis who, in May 2015, underwent percutaneous RFA for an HCV-related HCC in the VIII liver segment. The patient was in good clinical condition until June 2017, when a follow-up abdominal MRI showed a 25- × 20-mm hypovascular lesion of the III liver segment (Fig. 1A).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.Endoscopic treatment of internal hemorrhoids by use of a bipolar system
Hemorrhoids occur in 4% of the population and are identified in 39% to 45% of colonoscopies.1 Internal hemorrhoids have been categorized further according to the Banov classification, which has grades I to IV. Although grades III and IV have typically been managed surgically, grades I and II can be treated by endoscopic means.1-3Cholangioscopic 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.Cryoablation of a duodenal adenoma with intramucosal carcinoma
A 66-year-old man with Barrett’s esophagus presented for evaluation of a 2-cm sporadic duodenal bulb tubulovillous adenoma with high-grade dysplasia (HGD) (Fig. 1). EUS revealed sparing of the muscularis propria and the submucosa. Initial therapy consisted of piecemeal EMR (Duette Kit, Cook Medical, Bloomington, Ind). When residual lesions were found on follow-up examination, EMR was reattempted, but the lesion could not be lifted with submucosal injection, likely because of scar tissue. The patient then underwent more than 2 years of repeated applications of argon plasma coagulation (APC) and radiofrequency ablation (RFA) (HALO, now Barrx, Medtronic, Minneapolis, Minn), but the lesion persisted (Fig. 2) and developed a single minute focus of intramucosal carcinoma.Cryotherapy in gastrointestinal endoscopy
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported adverse events of a given technology. Both are supplemented by accessing the “related articles” feature of PubMed and by scrutinizing pertinent references cited by the identified studies.Stepwise endoscopic eradication of refractory nodular gastric antral vascular ectasia by use of detachable snare and band ligation
Gastric antral vascular ectasia (GAVE) is characterized by ectatic mucosal vessels with fibrin thrombi often localized to the gastric antrum. It is an uncommon cause of chronic GI blood loss associated with cirrhosis, autoimmune connective tissue disorders, bone marrow transplantation, and chronic kidney disease. Although GAVE often presents with characteristic flat, striped erythema radiating proximally from the pylorus (the so-called watermelon stomach), it can take on a nodular or polypoid appearance.
The content on this site is intended for healthcare professionals.
Copyright © 2023 Elsevier Inc. except certain content provided by third parties.
