The effects of endobiliary radiofrequency ablation in two patients with pancreatic cancer: Gross and microscopic findings

Publication date: December 2013 Source:Gastrointestinal Intervention, Volume 2, Issue 2 Author(s): Ryan Law , Madhava Pai , Todd H. Baron , Nagy Habib Endoscopic palliation of malignant biliary obstruction through the placement of plastic or self-expandable metal stents (SEMS) is the standard treatment for unresectable disease. Endobiliary radiofrequency ablation (RFA) is a therapeutic modality that has been recently used as a primary therapy to restore biliary patency in unresectable biliary malignancies and to treat occluded uncovered biliary SEMS because of tumor ingrowth. Preliminary animal studies have shown the tissue effects of RFA; however, the correlation of histopathologic findings in humans has not been reported. In this paper, we present two patients with a surgically resectable malignant distal biliary obstruction that was secondary to pancreatic adenocarcinoma. After they underwent biliary decompression, endobiliary RFA was performed. This was immediately followed by the placement of an uncovered biliary SEMS. Both patients subsequently underwent pancreaticoduodenectomy. A histopathologic review showed a circumferential zone of necrosis of 1.0–1.5 mm in depth. When compared to published animal data, the zone of necrosis was demonstrably reduced. These discrepant findings are likely multifactorial (e.g., heat-sink phenomenon, differences in study protocol, and comparison of dissimilar tissues). Based on our preliminary histopathologic findings, further...
Source: Gastrointestinal Intervention - Category: Gastroenterology Source Type: research