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Korean J Gastroenterol  <  Volume 75(1); 2020 <  Articles

Korean J Gastroenterol 2020; 75(1): 50-55  https://doi.org/10.4166/kjg.2020.75.1.50
Palliative Measures with Ethanol Gallbladder Ablation and Endobiliary Radiofrequency Ablation Followed by Endoscopic Biliary Stent Placement in an Advanced Case of Common Bile Duct Cancer: A Case Report
Yong-woo Lee1,2, Hyun Jeong Kim1,2, Sang Yub Lee3, Jun Heo1,2 and Min Kyu Jung1,2
Department of Internal Medicine, School of Medicine, Kyungpook National University1; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital2; Department of Radiology, School of Medicine, Kyungpook National University3, Daegu, Korea
Correspondence to: Min Kyu Jung, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-200-5514, Fax: +82-53-426-8773, E-mail: minky1973@hanmail.net, ORCID: https://orcid.org/0000-0001-8749-408X
Received: August 4, 2019; Revised: August 27, 2019; Accepted: October 2, 2019; Published online: January 25, 2020.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Endobiliary radiofrequency ablation (RFA) is a procedure performed widely to induce locoregional tumor control by the transfer of thermal energy to the lesion and subsequent tumor necrosis. A 72-year-old male with a prior history of acute calculous cholangitis and perforated cholecystitis was admitted to the Kyungpook National University Hospital complaining of fever and nausea. He had an indwelling percutaneous transhepatic gallbladder drainage (PTGBD) catheter from the previous episode of perforated cholecystitis. An abdominal CT scan showed marked dilation of both the intrahepatic and extrahepatic bile ducts. Common bile duct cancer was confirmed histologically after an endobiliary biopsy. A surgical resection was considered to be the initial treatment option. During open surgery, multiple metastatic nodules were present in the small bowel mesentery and anterior abdominal wall. Resection of the tumor was not feasible, so endobiliary RFA was performed prior to biliary stenting. Cholecystectomy was required for the removal of the PTGBD catheter, but the surgical procedure could not be performed due to a cystic ductal invasion of the tumor. Instead, chemical ablation of the gallbladder (GB) with pure ethanol was performed to breakdown the GB mucosa. Palliative treatment for a biliary obstruction was achieved successfully using these procedures. In addition, a PTGBD catheter was removed successfully without significant side effects. As a result, an improvement in the patient’s quality of life was accomplished.
Keywords: Gallbladder; Radiofrequency ablation; Cholangiocarcinoma; Cholangiopancreatography, endoscopic retrograde


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