Intraductal Ablation Techniques

  • Brian C. BrauerEmail author


In recent years, intraductal ablation technologies have emerged as an adjunct for unresectable pancreatic and biliary malignancies and also for treating ingrowth of metallic stents. Radiofrequency ablation (RFA), photodynamic therapy (PDT), and argon plasma coagulation (APC) are all existing technologies that have been adapted for the use within the biliary tree. Only radiofrequency ablation is FDA approved for use within the biliary tree; both PDT and APC are considered off-label uses. These technologies are safe overall and relatively easy for the experienced biliary endoscopist to use. When considering any of these therapies, a multidisciplinary approach with buy-in from all disciplines involved in the care of the patient is crucial to good outcomes and managing any adverse events that may occur.


Radiofrequency ablation Photodynamic therapy Argon plasma coagulation ERCP Pancreatic neoplasms Cholangiocarcinoma 

Supplementary material

Video 22.1

RFA treatment of an occluded uncovered metal biliary stent in a patient with unresectable pancreatic cancer (MP4 289422 kb)


  1. 1.
    Vincent A, Herman J, Schulick R, Hruban RH, Groggoins M. Pancreatic cancer. Lancet. 2011;378:607–20.CrossRefGoogle Scholar
  2. 2.
    Ramirez-Merino N, Aix SO, Cortez-Funes H. Chemotherapy for cholangiocarcinoma: an update. World J Gastrointest Oncol. 2013;5:171–6.Google Scholar
  3. 3.
    Khan AS, Fowler CJ, Chapman WC. Current surgical treatment strategies for hepatocellular carcinoma in North America. World J Gastroenterol. 2014;20:15007–17.CrossRefGoogle Scholar
  4. 4.
    Kadayifci A, Atar M, Forcione DG, et al. Radiofrequency ablation for the management of occluded biliary metal stents. Endoscopy. 2016;48:1096–101.CrossRefGoogle Scholar
  5. 5.
    Patel J, Rizk N, Kahaleh M. Role of photodynamic therapy and intraductal radiofrequency ablation in cholangiocarcinoma. Best Pract Res Clin Gastroenterol. 2015;29:309–18.CrossRefGoogle Scholar
  6. 6.
    Lais H, Sengoz C, Gonenc M. Endobiliary radiofrequency ablation for malignant biliary obstruction. Hepatobiliary Pancreat Dis Int. 2013;12:423–7.CrossRefGoogle Scholar
  7. 7.
    Kallis Y, Phillips N, Steel A, et al. Analysis of endoscopic radiofrequency ablation of biliary malignant strictures in pancreatic cancer suggests potential survival benefit. Dig Dis Sci. 2015;60:3449–55.CrossRefGoogle Scholar
  8. 8.
    Talreja JP, DeGaetani M, Ellen K, et al. Photodynamic therapy in unresectable cholangiocarcinoma: not for the uncommitted. Clin Endosc. 2013;46:390–4.CrossRefGoogle Scholar
  9. 9.
    Brauer BC, Fukami N, Chen YK. Direct cholangioscopy with narrow-band imaging, chromoendoscopy, and argon-plasma coagulation of intraductal papillary mucinous neoplasm of the bile duct. Gastrointest Endosc. 2008;67:574–6.CrossRefGoogle Scholar
  10. 10.
    Larghi A, Waxman I. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study. Gastrointest Endosc. 2006;63:853–7.CrossRefGoogle Scholar
  11. 11.
    Finsterer J, Stöllberger C, Bastovansky A. Cardiac and cerebral air embolism from endoscopic retrograde cholangio-pancreatography. Eur J Gastroenterol Hepatol. 2010;22:1157–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CampusAuroraUSA

Personalised recommendations