Mo1291 Radiofrequency Ablation for Biliary Metal Stent Occlusion: Evolution of a Novel Endoscopic Technique and Proof of Concept

Castleman disease (CD) rarely presents with obstructive jaundice, which poses a diagnostic and therapeutic challenge to the management of the disease. A 40-year-old man was referred to our hospital for emergent management of upper abdominal pain. An abdominal mass was removed, and the postoperative pathology showed retroperitoneum CD, which was subsequently managed by adjuvant therapy of combination chemotherapy and steroids. One month later, a biliary metal stent was placed due to the presentation of obstructive jaundice. After approximately 3 months, the patient experienced another episode of obstructive jaundice, and SpyGlass DS cholangioscopy (Boston Scientific, Natick, Mass, USA) was performed via the biliary track for biopsy, which pathologically showed biliary malignancies. Radiofrequency ablation was performed with a probe (EMcision, Montreal, Canada), and another uncovered metal stent was placed within the existing metal stent. No stent occlusion occurred during a 6-month follow-up period. In conclusion, CD rarely presents with obstructive jaundice, and a combination of radiofrequency ablation with metal stent implantation under cholangioscopy can prolong the stent patency time and the survival time of patients.

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Spontaneous Fracture of a Covered Self-Expandable Biliary Metal Stent and Endoscopic Technique for Removal

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2014/653693 ◽

2014 ◽

Vol 28 (8) ◽

pp. 411-412 ◽

Cited By ~ 3

Author(s):

Resheed Alkhiari ◽

Vishal Patel ◽

Lawrence Cohen

Keyword(s):

Endoscopic Technique ◽

Metal Stent ◽

Spontaneous Fracture ◽

Biliary Metal Stent

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Radiofrequency ablation combined with multiple biliary metal stent placement using short‐type single‐balloon endoscope in patients with surgically altered anatomy

Digestive Endoscopy ◽

10.1111/den.13016 ◽

2018 ◽

Vol 30 (3) ◽

pp. 395-396 ◽

Cited By ~ 2

Author(s):

Tadahisa Inoue ◽

Kiyoaki Ito ◽

Masashi Yoneda

Keyword(s):

Radiofrequency Ablation ◽

Stent Placement ◽

Metal Stent ◽

Surgically Altered Anatomy ◽

Single Balloon ◽

Biliary Metal Stent ◽

Short Type

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Efficacy of a paclitaxel-eluting biliary metal stent with sodium caprate in malignant biliary obstruction: a prospective randomized comparative study

Endoscopy ◽

10.1055/a-0754-5763 ◽

2018 ◽

Vol 51 (09) ◽

pp. 843-851 ◽

Cited By ~ 3

Author(s):

Sung Ill Jang ◽

Kyu Taek Lee ◽

Jung Sik Choi ◽

Seok Jeong ◽

Don Haeng Lee ◽

...

Keyword(s):

Biliary Obstruction ◽

Stent Migration ◽

Survival Duration ◽

Stent Insertion ◽

Metal Stent ◽

Stent Occlusion ◽

Sodium Caprate ◽

Multiple Treatment ◽

Basic Characteristics ◽

Biliary Metal Stent

Abstract Backgrounds The placement of a self-expandable metal stent (SEMS) is widely used in patients with unresectable malignant biliary obstructions, but SEMSs are susceptible to occlusion by tumor ingrowth or overgrowth. The efficacy and safety of a novel paclitaxel-eluting biliary metal stent incorporating sodium caprate (MSCPM-III) were compared prospectively with those of a covered metal stent (CMS) in patients with malignant biliary obstructions. Methods Patients with unresectable distal malignant biliary obstructions (n = 106) were prospectively enrolled in this study at multiple treatment centers. Stents were placed endoscopically: MSCPM-III in 54 patients and CMS in 51 patients. The patients received systemic chemotherapy regimens according to their disease characteristics. Results The two groups did not differ significantly in basic characteristics or mean follow-up period. Stent occlusion occurred in 14 patients who received MSCPM-III and in 11 patients who received CMS. Time to recurrent biliary obstruction (RBO) and survival time did not differ significantly between the two groups (P = 0.84 and P = 0.29, respectively). However, tumor size at 2 months after stent insertion was significantly decreased in patients in the MSCPM-III group with bile duct cancers or those who experienced stent migration compared with the CMS group. Complications, including cholangitis and pancreatitis, were found to be acceptable in both groups. Conclusions Although compared with a CMS the MSCPM-III did not significantly influence time to RBO or survival duration in patients with malignant biliary obstructions, MSCPM-III reduced tumor volume and was used safely in humans.

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Repeat Metal Stenting May Be Optimal Initial Treatment for Biliary Metal Stent Occlusion in Malignancy

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2008.03.383 ◽

2008 ◽

Vol 67 (5) ◽

pp. AB167 ◽

Cited By ~ 1

Author(s):

Jason N. Rogart ◽

Uzma D. Siddiqui ◽

Priya A. Jamidar ◽

Harry R. Aslanian

Keyword(s):

Initial Treatment ◽

Metal Stent ◽

Stent Occlusion ◽

Biliary Metal Stent

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Faculty Opinions recommendation of EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718075899.793482195 ◽

2013 ◽

Author(s):

Steve Pereira

Keyword(s):

Metal Stent ◽

Biliary Diversion ◽

Biliary Metal Stent

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Feasibility and Safety of Endoluminal Radiofrequency Ablation as a Rescue Treatment for Bilateral Metal Stent Obstruction Due to Tumor Ingrowth in the Hilum: A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10050952 ◽

2021 ◽

Vol 10 (5) ◽

pp. 952

Author(s):

Hoonsub So ◽

Chi Hyuk Oh ◽

Tae Jun Song ◽

Hyun Woo Lee ◽

Jun Seong Hwang ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Bile Duct ◽

Adverse Events ◽

Bile Duct Obstruction ◽

Metal Stents ◽

Metal Stent ◽

Duct Obstruction ◽

Tumor Ingrowth ◽

Malignant Bile Duct Obstruction ◽

Hilar Bile Duct

Background. Radiofrequency ablation (RFA) is a palliative method known for its application in the endoscopic treatment of malignant bile duct obstruction. It may be a useful rescue method for metal stent malfunction caused by tumor ingrowth. This study aimed to examine the feasibility and safety of endoluminal RFA for occluded bilateral hilar metal stents due to tumor ingrowth in patients with malignant hilar bile duct obstruction. Methods: From March 2016 to June 2018, 11 patients with unresectable malignant hilar bile duct stricture with occluded bilateral hilar metal stents due to tumor ingrowth were enrolled. Endoluminal RFA was performed through a novel temperature-controlled catheter at a setting of 7 W power for 120 s with a target temperature of 80 °C via endoscopic retrograde cholangiopancreatography (ERCP). The patients’ demographics, clinical outcomes, and adverse events were investigated. Results: The median age was 64 (interquartile range, 54–72) years. All RFA procedures were successful. Clinical success was achieved in eight patients (72.7%). During the follow-up, eight patients (72.7%) showed stent dysfunction, and the median patency after RFA was 50 days (95% confidence interval (CI): 34–not available (NA)). All stent dysfunctions were successfully managed with ERCP. Ten patients died, and the median overall survival was 289 days (95% CI, 107–NA) from RFA to death. There was one case of mild abdominal pain after the procedure without serious adverse events. Conclusions: As a rescue therapy for occluded bilateral hilar metal stents due to tumor ingrowth, endoluminal RFA seemed to be safe and useful in selected patients.

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