I just wanted to show you a couple of things about biliary RFA. We use this for treatment of certain bile duct malignancies that are not amenable to surgical resection. Here's a 65 year old woman with multiple medical problems who had an ampullary high grade dysplastic adenoma. She had a successful endoscopic ampulectomy, but she had some sub-centimeter length of intraductally extending ampullary adenomas, so the referring endoscopist asked if I could use an RFA probe to do this. This is a 10 French device, and I just wanted to share with you the settings that I prefer. I have an Irby Bio electrosurgical generator. I use soft coag, I set it on 7 watts, effect 8. Remember this is bipolar device, so there's no ground pad. I step on the pedal for 90 seconds. Some people like two minutes. I use 90 seconds. I wait about three minutes before I withdraw the probe, thinking that that may reduce the risk of bleeding somewhat, and our entire group of ERCPists leaves a stent behind after this. This has a couple of electrodes. The burn goes just a couple of millimeters deep, and as you can see, a little bit of an indentation where that intraductal tumor is as I inject there, and this is the probe, so I try to make sure that the electrodes are in the area where that tumor is, and step on the pedal for 90 seconds. It goes in over a guide wire, and at the end, over the same wire, place a stent. It's actually really simple to do it. This is the device. There's one of the electrodes going in, and the second electrode, I think you can see that, and then perform your treatments for 90 seconds, and then here goes the plastic stent being inserted, and then the patient comes back to have that retrieved in a couple of weeks.

biliary RFA

radiofrequency ablation

bile duct malignancies

ampulla

high-grade dysplastic adenoma