Tools and Techniques of Endoscopic Radiofrequency Ablation in Pancreaticobiliary Diseases: A Narrative Review

Endoscopic radiofrequency ablation (RFA) has become an established minimally invasive option for patients with pancreaticobiliary tumors who are not candidates for resection or who have obstructing lesions of the bile duct or pancreas. This narrative review summarizes the devices, technique, and supporting clinical evidence for endoscopic RFA, organized by clinical indication rather than by device alone.

RFA delivers high-frequency alternating current that produces localized thermal injury and coagulative necrosis. Two endoscopic delivery routes are in use: an ERCP-guided approach, which treats intraductal lesions such as malignant biliary strictures and ampullary tumors using bipolar endobiliary catheters, and an EUS-guided approach, which uses a monopolar needle electrode to ablate pancreatic parenchymal lesions, including solid tumors, neuroendocrine tumors, and pancreatic cysts and intraductal papillary mucinous neoplasms (IPMN). Hybrid needles that combine fine-needle aspiration with ablation are an emerging, still investigational, third category.

Across the published series, technical success generally exceeds 90% for both approaches, with adverse event rates that are mostly low and dominated by self-limited abdominal pain, mild pancreatitis, or cholangitis; perforation and clinically significant bleeding are uncommon when established energy and safety-margin parameters are followed. A proposed, but still poorly characterized, immune-stimulating effect of ablation-induced tissue injury is discussed as a hypothesis rather than an established mechanism.

Taken together, the available data support endoscopic RFA as a useful adjunct in the multidisciplinary management of pancreaticobiliary disease, but most of the supporting literature consists of small, single-arm, or retrospective series. Prospective, ideally randomized, studies with standardized energy protocols and longer follow-up are needed before the technique's role in routine practice, particularly for pancreatic cystic lesions and IPMN, can be considered settled.