Biliary tract perforation following percutaneous endobiliary radiofrequency ablation: A report of two cases

Abstract

Abstract. Endobiliary radiofrequency ablation (RFA) has recently been recognized as a beneficial treatment option for malignant biliary obstruction using percutaneous or endoscopic approaches. The feasibility and safety of this method has been demonstrated in clinical studies, with pain, cholangitis and asymptomatic biochemical pancreatitis reported as relatively common complications. By contrast, hepatic coma, newly diagnosed left bundle branch block and partial liver infarction have been reported as uncommon complications. Biliary tract perforation is a serious potential complication of percutaneous intraductal RFA, which may result in severe infection, peritonitis or even mortality, and which has not been previously reported in clinical research. The current study presents the first reports of biliary tract perforation in two patients with unresectable malignant biliary obstruction following percutaneous intraductal RFA. Although the patient in case 1 succumbed 12 days after RFA, the minor biliary tract perforation in case 2 was successfully treated by the deployment of a self-expanding metal stent. This study demonstrates that biliary tract perforation should be recognized as a serious potential complication of endobiliary RFA, and that metal stent deployment should be considered as a treatment option for minor biliary tract perforation.

Evaluation of the safety of endoscopic radiofrequency ablation for malignant biliary stricture using a digital peroral cholangioscope (with videos)

“…In contrast, the rate of adverse events associated with RFA was not very low in previous reports. As a serious adverse event, bile duct perforation was reported . In this report, RFA was carried out by percutaneous guidance.…”

“…However, the adverse events rate has been reported to range widely, from 0 to 62% . In addition, severe adverse events such as procedure‐related death (hemorrhagic shock) or biliary tract perforation have also been reported. If cholangioscopic findings of malignant stricture are not seen in the biliary tract, severe adverse event such as perforation or bleeding as a result of vessel injury around the biliary tract may occur.…”

Usefulness of intraductal RFA in patients with malignant biliary obstruction

“…However, ID-RFA in perihilar applications has the potential to cause bile duct perforation and vascular injuries, such as hemobilia and liver infarction, because the hilar bile duct is located near the hepatic artery and portal vein complexes. [ 4 – 6 ] We aimed primarily to evaluate the feasibility and clinical outcomes of temperature-controlled hilar ID-RFA in patients with perihilar malignant biliary obstruction. Secondly, we sought to compare the clinical efficacy of a bilateral SEMS and PS after hilar ID-RFA.…”

Acute and Subacute Effects of Irreversible Electroporation on Normal Common Bile Ducts in a Rabbit Model

“…Intraductal RFA with an endobiliary catheter (Habib EndoHPB; EMcision, London, UK) has been designed to potentially improve the stent patency and survival rates [11,12]. However, because of heat sink and thermal injury, its clinical use was confined by the risk of treatment-related complications and limited efficacy [13][14][15].…”