Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma

Figure 6 A patient with unresectable cholangiocarcinoma was previously treated with photodynamic therapy followed by placement of an uncovered metal stent (see Figure 2). For persistent symptomatic biliary obstruction due to undrained segments in the right liver, a wire was passed into the previously undrained segments which allowed for 6-Fr bougie dilation followed by 4-mm balloon dilation across the lattices of the existing large-cell uncovered self-expandable metal stent (SEMS) (not shown). After dilation, the 8-Fr radiofrequency ablation (RFA) catheter was deployed over the wire and through the SEMS, and RFA was applied to a malignant stricture that was obstructing drainage (A). Lastly an 8-mm uncovered SEMS was deployed through the previously placed 8-mm uncovered SEMS (B) enabling durable drainage of more of the right liver.