Endoscopic hemostasis for tumor bleeding using intraductal radiofrequency ablation.

Bleeding hepatobiliary tumors can sometimes be critical in patients with advanced malignancy. Several methods can be used to achieve hemostasis, such as the placement of a covered metal stent or vessel coiling under angiographic control. If tumor bleeding occurs near the mid or lower bile duct, a fully coveredmetal stent can be placed for hemostasis; however, this method may be challenging if there is bleeding at the hepatic hilum or when bleeding is inactive. Recently, intraductal radiofrequency ablation (RFA) has been reported to provide prolonged stent patency [1,2]. This technique may however also be clinically useful for achieving hemostasis. Herein, we present technical tips for achieving hemostasis of tumor bleeding using intraductal RFA. An 80-year-old man with a history of uncovered metal stent insertion for advanced cholangiocarcinomawas admitted to our hospital with frequent cholangitis and anemia secondary to tumor bleeding. We needed to achieve hemostasis and insertion of an endoscopic retrograde cholangiopancreatography (ERCP) catheter into the common bile duct revealed bleeding from the ampulla of Vater (●" Fig.1). Next, using a guidewire, we inserted a digital cholangioscope (SpyGlass Direct Visualization System) into Fig.3 The 8-Fr bipolar probe that was used to perform intraductal radiofrequency ablation.