Suarez Alejandro L, Coté Gregory A, Elmunzer B Joseph
Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, S.C. USA.
Endosc Int Open. 2016 Jul;4(7):E748-51. doi: 10.1055/s-0042-107665. Epub 2016 Jun 29.
Catheter-based radiofrequency ablation (RFA) delivered during endoscopic retrograde cholangiopancreatography (ERCP) may represent a viable treatment option for intraductal extension of ampullary neoplasms, however, clinical experience with this modality is limited. After ampullary resection, 4 patients with intraductal extension underwent adjunctive RFA of the distal bile duct. All patients received a temporary pancreatic stent to reduce the risk of pancreatitis, as well as a plastic biliary stent to prevent biliary obstruction. Three patients were treated for adenoma and 1 for adenoma with a focus of adenocarcinoma. During a short follow-up period, 3 patients experienced complete eradication of the target lesion, whereas the patient with a focus of adenocarcinoma had progression to overt invasive cancer. There were no immediate adverse events. One patient developed a post-RFA bile duct stricture, which has required additional endoscopic therapy. Catheter-based RFA of ampullary lesions that extend up the bile duct is technically feasible. Additional research is necessary to understand the risks and long-term benefits of this technique.
在内镜逆行胰胆管造影术（ERCP）期间进行的基于导管的射频消融（RFA）可能是壶腹肿瘤导管内扩展的一种可行治疗选择，然而，这种治疗方式的临床经验有限。壶腹切除术后，4例有导管内扩展的患者接受了远端胆管的辅助RFA治疗。所有患者均接受了临时胰腺支架以降低胰腺炎风险，以及塑料胆管支架以防止胆道梗阻。3例患者接受腺瘤治疗，1例接受伴有腺癌灶的腺瘤治疗。在短期随访期间，3例患者的靶病变完全消除，而伴有腺癌灶的患者进展为明显的浸润性癌。无即刻不良事件发生。1例患者发生了RFA术后胆管狭窄，需要额外的内镜治疗。对胆管内扩展的壶腹病变进行基于导管的RFA在技术上是可行的。有必要进行更多研究以了解该技术的风险和长期益处。
