Endoscopic intraductal management of non-calculus biliary lesions

As increasing in endoscopic management of non-calculus biliary diseases, the options of methods to be selected also increased. Beside the drainage, intraductal management has become more mature than before, especially with the introduction of new peroral cholangioscopy. Intraductal management of non-calculus lesions are majorly for tumors. Intraductal radiofrequency, photodynamic therapy, irreversible electroporation and laser and drug-delivery stenting have been applied clinically or experimentally.
RFA is commonly used for pre-stenting of malignant stricture, ampullary tumors and treatment of occluded metallic stents. Photodynamic therapy is one kind of laser non-thermal ablative therapy with the need of photosensitizer. Cost & phototoxicity limit the use. Some studies showed the comparable treatment result of FRA & photodynamic therapy.
Lasers are devices that emit a single, coherent wavelength of electromagnetic radiation that is used to cut, coagulate, or ablate tissue for a variety of clinical applications. Application of laser for bile duct cancers has been tried in animal model in a study. Diode laser was used and the authors showed that the temperature distribution obtained proved to induce a safe and effective intraductal coagulative necrosis of biliary ducts. Intraductal laser local tumor ablation & hemostasis could be achieved with laser. Besides laser lithotripsy, we use Holmiun YAG laser for local ablation of bile duct tumor and bleeding under the guidance of peroral cholangioscopy.
With the advancement of interventional EUS, the intraductal management of bile duct lesions could be achieved via EUS created fistula.