A Case of Direct Peroral Cholangioscopy-Guided Intraductal Radiofrequency Ablation for Malignancy Biliary Obstruction via Choledochoduodenostomy Orifice

BAlthough intraductal radiofrequency ablation (RFA) has been reported to be a feasible treatment of malignancy biliary obstruction in unresectable cholangiocarcinoma, endoscopic retrograde cholangiopancreatography (ERCP)guided intraductal RFA has a disadvantage that cannot be directly visualize the biliary tract using the fluoroscopic image. On the other hand, direct peroral cholangioscopyguided intraductal RFA is easy to insert catheter and apply treatment by visualizing the bile duct lesions. We present a case of direct peroral cholangioscopyguided intraductal RFA without biliary stent in 67-year-old woman patient with cholangiocarcinoma for treatment of malignancy biliary obstruction. In the past, she underwent choledochoduodenostomy for intrahepatic stones. She underwent direct peroral cholangioscopy-guided intraductal RFA via choledochoduodenostomy orifice, and biliary patency was preserved for 90days without additional treatment such as biliary stent and severe complication. Direct peroral cholangioscopy-guided intraductal RFA is expected to be able to reduce the complications of the procedure by ensuring the bile duct lesions. Prospective studies with long term follow up are warranted.