title: Radiofrequency ablation for intraductal extension of ampullary neoplasms.
abstract: OBJECTIVE
  Extension of ampullary adenomas into the common bile duct (CBD) or pancreatic duct (PD) may be difficult to treat endoscopically. We evaluated the feasibility, safety, and efficacy of endoscopic radiofrequency ablation (RFA) in the management of ampullary neoplasms with intraductal extension.
  
  
  METHODS
  This was a multicenter, retrospective analysis of all patients with intraductal extension of ampullary neoplasms treated with endoscopic RFA between February 2012 and June 2015. Treatment success was defined as the absence of detectable intraductal polyps by ductography, visual inspection, and biopsy sampling.
  
  
  RESULTS
  Fourteen patients with adenoma extension into the CBD (13 ± 7 mm, n = 14) and PD (7 ± 2 mm, n = 3) underwent a median of 1 RFA sessions (range, 1-5). Additional modalities (thermal probes, argon plasma coagulation, and/or photodynamic therapy) were also used in 7 patients, and prophylactic stents were routinely placed. Thirteen assessable patients underwent a median of 2 surveillance ERCPs after completion of treatment over a median follow-up of 16 months (range, 5-46), with intraductal biopsy specimens showing no neoplasm in 12 patients at the conclusion of endoscopic treatment. Treatment success was achieved in 92%, including 100% of those treated with RFA alone. Adverse events occurred in 43% and included ductal strictures (5 patients) and retroduodenal abscess (1 patient), all of which were successfully treated endoscopically.
  
  
  CONCLUSIONS
  Endoscopic RFA, alone or in combination with other modalities, may effectively treat intraductal extension of ampullary neoplasms. Ductal strictures were common after RFA but responded to endoscopic stent therapy. RFA may be appropriate in selected patients, particularly when the main treatment alternative is pancreaticoduodenectomy.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Rustagi
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors.forename: Shayan
authors.initials: S
authors.lastname: Irani
authors.affiliation: Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India.
authors.forename: D Nageshwar
authors.initials: DN
authors.lastname: Reddy
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Barham K
authors.initials: BK
authors.lastname: Abu Dayyeh
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: John
authors.initials: J
authors.lastname: Martin
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bret T
authors.initials: BT
authors.lastname: Petersen
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ross
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater; D001706:Biopsy; D017115:Catheter Ablation / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000473:pathology; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010183:Pancreatic Ducts / Q000473:pathology; D000078702:Radiofrequency Therapy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome