Radiofrequency ablation for intraductal extension of ampullary adenomatous lesions: proposal for a standardized protocol

Abstract

Background and study aims Intraductal extension of ampullary adenoma represents a challenging endoscopic issue. Intraductal radiofrequency ablation (RFA) has been recently suggested, but evidence and standardization of this technique are still lacking. This study aimed to provide a long-term evaluation of clinical efficacy and safety of intraductal RFA ablation with a standardized algorithm of treatment. Patients and methods Data were prospectively collected from consecutive patients with intraductal extension of adenomatous ampullary lesions from January 2016 to November 2018. Endpoints of the study were clinical success evaluated on histology results at the last follow-up, technical success, and adverse events assessment. Results Nine patients with intraductal (biliary ± pancreatic) extension of ampullary adenomas were treated with RFA during the study period. Histology on the papillectomy specimen confirmed intraductal involvement with low-grade dysplasia (LGD) in five cases (56 %), high-grade dysplasia (HGD) in three (33 %), and HGD with intramucosal adenocarcinoma in one patient (11 %). Additional argon plasma coagulation to ablate the adenoma on the duodenal mucosa was applied in five patients (56 %). Technical success was 100 %. One patient (11 %) with failed pancreatic stenting, developing acute pancreatitis after RFA, recovered with medical therapy. After a median follow-up of 21 months (IQR 20–31), six patients (67 %) achieved clinical success being free of recurrence, whereas one was diagnosed with persistence of adenocarcinoma, one with recurrent HGD, and one with recurrent LGD. Conclusions In our experience, intraductal RFA achieved acceptable results after a 2-year follow-up. Further studies are required to confirm our results and to select those patients most likely to respond.

Radiofrequency ablation for ampullary neoplasia with intraductal extension after endoscopic papillectomy: Systematic review and meta-analysis

“…(Figure 1) A total of 12 were utilized for qualitative synthesis and 7 for quantitative synthesis, totaling 124 patients. [12][13][14][15][23][24][25] Five studies were excluded from the quantitative analysis due to duplicate data (Table 2).…”

“…The VIVA Combo generator (STARmed, Seoul, South Korea) was employed for intraductal RFA delivery, providing precise control over power settings, target temperature, and impedance. [14,15,23] The Habib catheter it is an 8 French (2.7 mm) sizable bipolar RFA probe, extending 180 cm in length, and is equipped with two ring electrodes that are spaced 8 mm apart, and the distal electrode is positioned 5 mm from the front edge. The catheter was attached to an electrosurgical generator, with options including the RITA 1500X from Angiodynamics in Latham, NY, the Erbe system from Surgical Technology Group in Hampshire, England, U.K., or the Beamer from ConMed.…”

“…[4][5][6][7][8][9] Given the recurrence rate of endoscopic resection and the risks related to surgery, recent studies have shown the benefits of radiofrequency ablation (RFA) for residual lesions and as a complementary therapy for an intraductal extension. [2,4,5,[10][11][12][13][14][15] RFA acts directly on residual neoplastic tissue, causing necrosis from the resulting thermal energy, and determines highly immunogenic intracellular components like heat shock proteins. [16][17][18] To better understand the outcomes of this novel approach, we performed a systematic review and meta-analysis evaluating the efficacy and safety of RFA for residual or recurrent lesions with intraductal extension after EP .…”

Updates in endoscopic management of ampullary and duodenal adenomas

“…In recent years, radiofrequency ablation (RFA) of the bile duct has been commercially available. In two studies, the efficacy of intraductal RFA was 75% and 92.3% respectively [40,41]. A single session of RFA eradicated dysplasia in 70% patients at 12 months follow up.…”

Efficacy of biliary radiofrequency ablation for the treatment of residual and recurrence neoplasia after endoscopic papillectomy

“…One patient died from a severe acute pancreatitis. We reported 3 early complications (two pancreatis whom one mild and one fatal and one bleeding) (12%) and twelve late complications (48%) of a stenosis type, successfully managed endoscopically 1 2 3 .…”