A case of hepatocellular carcinoma treated by radiofrequency ablation confirming the adjacent major bile duct under hybrid contrast mode through a biliary drainage catheter

Abstract

Bile duct injury is a potential complication of radiofrequency ablation (RFA). Bipolar RFA devices have recently become available. Because visibility of the bipolar RFA electrodes is not good on ultrasonography, more careful usage of the electrodes to avoid bile ducts is needed. We present a case with hepatocellular carcinoma (HCC) located near the B5 intrahepatic bile duct. To view the bile duct, we used contrast medium for ultrasonography, administered through a biliary drainage catheter for endoscopic nasobiliary drainage (ENBD). Infusing the contrast medium allowed clear visualization of the HCC adjacent to the major bile duct during RFA. We also used a navigation system for bipolar RFA to confirm positions of the electrodes and HCC. We confirmed complete ablation of the HCC while avoiding bile duct injury and late bile duct stenosis. Administration of contrast medium for ultrasonography through an ENBD tube appears useful to avoid bile duct injury during RFA.

Improving Ablation Safety for Hepatocellular Carcinoma Proximal to the Hilar Bile Ducts by Ultrasound-MR Fusion Imaging: A Preliminary Comparative Study

“…However, the therapeutic effect of PEI or TACE is limited compared to that of RFA. Another strategy is intraductal chilled saline perfusion through an endoscopic nasobiliary drainage (ENBD) tube or a percutaneous transhepatic cholangial drainage (PTCD) tube to cool the large bile duct during the RFA procedure (11)(12)(13)(14)(15). However, both catheterization procedures are invasive and may lead to unexpected pancreatitis.…”

Efficacy of Percutaneous Thermal Ablation Combined With Transarterial Embolization for Recurrent Hepatocellular Carcinoma After Hepatectomy and a Prognostic Nomogram to Predict Survival

“…Indeed, in contrast to hepatectomy, patients with multiple nodules, large tumor, or vascular invasion could obtain more benefit from ablation than resection. 37 – 41 …”

“…Indeed, in contrast to hepatectomy, patients with multiple nodules, large tumor, or vascular invasion could obtain more benefit from ablation than resection. [37][38][39][40][41] Transarterial chemoembolization could treat patients with rHCC, but the repeat recurrence rate was as higher as 75% and 93% in 3-and 6-month follow-up, respectively. Thus, TACE might be a good approach to control the progression of macroscopic nodules, instead of preventing new recurrence.…”