Post written by Ana Luísa Lopes dos Santos Silva, MD, from the Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.

Our video reports 3 patients with a diagnosis of perihilar cholangiocarcinoma, who underwent endoscopic radiofrequency ablation with palliative intent. In all cases, endoscopic retrograde cholangiopancreatography with single-operator cholangioscope was performed due to cholestasis symptoms to treat obstructive jaundice and evaluate the longitudinal extension of the cholangiocarcinoma. Radiofrequency treatment was performed using Habib™ EndoHPB bipolar radiofrequency catheter (Boston Scientific) and the electrosurgical generator ERBE 200D. Generator settings were: power 10W, effect 8, energy for 45 seconds x 2 cycles. RF was repeated until all stricture was treated. Prior to treatment, the location and extent of the stricture was documented on fluoroscopy and cholangioscopy. In the end self-expandable metal stents were placed to promote drainage. No adverse events occurred and 1 month later patients presented analytical and clinical improvement. The first and second patients died 13 and 5 months after RFA, respectively. The third patient stayed alive 13 months after RFA having presented with cholangitis, with no adverse events 5 months after the procedure.  

Our video illustrates the role of intraductal RFA in the treatment of obstructive jaundice in patients with irresectable perihilar cholangiocarcinoma. After combined treatment with RFA and SEMS there was rapid improvement in cholestasis in all patients. In video form, we intended to show, step-by-step, the entire procedure, namely the ease of endoscopic management without several adverse events and the possibility of repeating the procedure until the stricture is resolved.   

Our video and its explanation reflects our experience with this type of palliative treatment, allowing other endoscopists to see a recent endoscopic approach of palliative cholangiocarcinoma that could bring benefit in terms of stent patency and symptom relief in cases of nonsurgical cholangiocarcinoma. By highlighting the practical applications of this technique, with explication of settings used, we are sure that this technique could be extended and applicable in other centers.

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