Hyperkalemia after endobiliary radiofrequency ablation for malignant biliary obstruction

Abstract

possess some degree of inherent limitations. [1][2][3] However, the development of the second-generation single-operator cholangioscopy system (SpyGlassDS; Boston Scientific, Watertown, MA, USA) has resulted in a significant improvement in the diagnostic sensitivity to 75-85%, and we have recently shown in a randomized trial that an accurate diagnosis can be established in 90% of patients with indeterminate biliary strictures. 4,5 Recently, new cholangioscopy biopsy forceps have been developed (SpyBite Max Biopsy Forceps; Boston Scientific) with a larger jaw outer diameter of 1.0 mm, with the aim of procuring a greater quantity of tissue. However, there are, to date, no studies comparing standard cholangioscopy biopsy forceps (SpyBite Biopsy Forceps) with these novel biopsy forceps in tissue procurement in indeterminate biliary strictures. Therefore, we conducted a case-control study comprising two groups (standard [n = 56] vs. novel biopsy forceps [n = 28]), which were matched for age and gender in a 2:1 ratio, in order to compare the procured tissue area. A specialized image analysis software (Nikon-NIS Elements Basic Research Software, Tokyo, Japan) was utilized to quantify the area of biopsy specimens procured.While there was no significant difference in the mean number of biopsies required to achieve diagnosis (mean [SD] for large biopsy forceps 2.8 [2.9] vs. standard forceps 2.1 [2.5], P = 0.251), the mean tissue area per specimen was significantly higher in the larger biopsy forceps group (357,152 vs. 247,058 µm 2 , P = 0.025) (Table 1, Fig. 1a-d).In this study, when compared to the standard cholangioscopy biopsy forceps, the novel larger biopsy forceps procured significantly greater tissue area per biopsy. In addition to better histopathological interpretation, these findings may have important implications for molecular profiling in the era of personalized medicine for cancer.

Impact of endobiliary radiofrequency ablation on survival of patients with unresectable cholangiocarcinoma: a narrative review

“…The rapid flow of bile through the strictures ensured by SEMS could have a cooling effect preventing deep bile duct injuries ( 23 ). Hyperkalemia was the cause of a sudden non-fatal cardiac failure in a patient with chronic kidney disease who underwent ERFA for the treatment of a biliary stricture at the time of biliary drainage ( 80 ). Another three cases of non-lethal heart failure occurred in two patients with a history of coronary heart disease and hypertension within 24 hours after ERFA ( 20 , 74 ).…”

“…To reduce the risk of unintended strictures an accurate measurament of the stricture is required, especially if the biliary stenosis is long and requires ovelapping ERFA (18,55,56,78). Few life-threathening adverse events have been reported (20,36,50,62,(79)(80)(81). Therefore, it is important for the biliary endoscopist to be aware of these complications.…”