Refractory Jaundice From Intraductal Papillary Mucinous Neoplasm Treated With Cholangioscopy-Guided Radiofrequency
Nicholas G Brown1, Joel Camilo2, Martin McCarter3
1Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
Insights
Biliary radiofrequency ablation (RFA) with cholangioscopy effectively palliated obstructive jaundice from pancreatic IPMN. This approach facilitated surgery and improved patient outcomes, offering a potential bridge to definitive treatment.
Area of Science:
- Gastroenterology and Hepatology
- Oncology
- Interventional Endoscopy
Background:
- Intraductal papillary mucinous neoplasms (IPMNs) are premalignant epithelial neoplasms requiring surgical management.
- Obstructive jaundice is a common complication of pancreatic IPMNs, often managed with endoscopic stenting.
- Refractory biliary obstruction presents a significant clinical challenge.
Observation:
- A 79-year-old male presented with jaundice refractory to endoscopic stenting.
- The jaundice was caused by a mucin-producing pancreatic IPMN with a fistulous biliary communication.
- Cholangioscopy-guided biliary radiofrequency ablation (RFA) was employed for palliation.
Findings:
- Biliary RFA successfully palliated obstructive jaundice, leading to clinical improvement.
- The patient's condition stabilized, allowing for subsequent surgical resection.
- The patient achieved pre-illness status at 17 months post-intervention.
Implications:
- Cholangioscopy-guided RFA is a viable palliative option for obstructive jaundice due to pancreatic IPMN.
- This technique can serve as a bridge to surgical resection in select cases.
- It offers a minimally invasive approach to manage complex biliary obstructions caused by mucinous neoplasms.
Abstract:
Intraductal papillary mucinous neoplasms (IPMNs) are epithelial neoplasms treated with surgical resection when appropriate. We present a 79-year-old man with jandice refractory to endoscopic stenting. Biliary radiofrequency ablation (RFA) with cholangioscopy was used as palliation of obstructive jaundice due to a mucin-producing pancreatic IPMN with fistulous biliary communication. Clinical improvement permitted surgery, and he returned to pre-illness status at 17 months. The use of cholangioscopy in the setting of mucinous filling defects can guide over-the-wire RFA for palliation and may be a bridge to surgery.
