Utility of radiofrequency ablation therapy for residual intraductal lesions after endoscopic papillectomy for ampullary adenomas

Background and Aims: Treatment of residual intraductal lesions after endoscopic papillectomy (EP) for ampullary adenomas is challenging. Several studies have recently conducted intraductal radiofrequency ablation (RFA) to achieve the radical treatment of such lesions. Here, we evaluated the utility of RFA for residual intraductal lesions after EP for ampullary adenomas.
Methods: Patients who received RFA for residual intraductal lesions after EP were retrospectively reviewed. The RFA catheter (Habib EndoHPB) was inserted across the end of the common bile duct under fluoroscopic guidance, and a VIO3 generator (Erbe Elktromedizin) was applied at 30W for 30s during pancreatic stent placement. After ablation, biliary stent placement was performed with a fully covered self-expandable metal stent. Clinical data were collected, including residual intraductal lesions 6 months after RFA, additional surgery, and adverse events.
Results: Four patients (61.5 years of age, all men) were included. In all patients, the residual intraductal lesions were high-grade adenoma whose mean extension was 8.8 in diameter. All underwent 1 successful RFA session and recovered uneventfully. There were no residual intraductal lesions after RFA and no need for additional surgery. Two patients (50%) experienced biliary stricture for 6 months of follow-up, which were endoscopically treated.
Conclusions: In our experience, RFA achieved acceptable results for treating residual intraductal lesions after EP. However, larger-scale clinical studies with long-term follow-up are needed.