3461 Endoscopic destruction of ampullary and bile duct carcinomas by high intensity ultrasound during ercp: preliminary results of a pilot study

• Published in: Gastrointestinal endoscopy 2000-04, Vol.51 (4), p.AB98-AB98
• Main Authors: Prat, Frederic, Cyril, Lafon, Yves, Theilliere, Gilles, Pelletier, Jacques, Fritsch, Dominique, Cathignol, CHU, Bicetre
• Format: Article
• Language: English
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(00)14161-6

Biliary carcinomas are often beyond curative resource because of tumour extension or patient's age or general condition. However, local and infiltrative extension would make some of these tumours accessible to non-operative intra-ductal destruction, for palliative or even curative purposes. Aims : to assess the clinical feasibility and short term results of local tumour destruction by an intra-ductal high intensity US probe during ERCP. Methods : the probe is a 2m-long, 2.7mm in diameter flexible catheter provided with a 8x2.8mm US transducer, and a lumen for a.018'' guidewire ; it can be inserted into a 4.2mm operating channel. 6 patients (4 women, 2 men, mean age 76 years) have been included and treated so far. There were 1 ampullary carcinoma, 4 common bile duct cholangiocarcinomas and 1 hilar carcinoma. All were histologically proven and had been assessed preoperatively by CT-scan and EUS. Two common bile duct carcinomas were candidates for curative surgery and received US pre-operatively. 4 patients underwent control ERCP + cholangioscopy. Treatment was performed during a standard ERCP session : the probe was inserted through the tumour stricture and US therapy was applied over 360° by rotating the probe under fluoroscopic control. The transducer was moved along the stricture to cover the tumour completely. ERCP was completed by insertion of a standard 11.5Fr stent. Results : Treatment was well tolerated in all patients, and no serious adverse effects have been observed ; one patient presented right upper abdominal pain during 12 hours, without evidence of relationship with US treatment. In one patient operated on after US, tumour extended beyond the treated area and resection was precluded, but biopsies of the treated area revealed inflammation without tumour. In the 2nd operated patient, resection was possible and histology revealed extensive coagulation necrosis with inflammation up to 10mm in depth all around bile duct lumen. Control ERCP showed persistance, but dramatic change of the stricture pattern in 2 patients (no tumour on biopsies in one), and complete regression of stricture in the 3rd one, with no further stenting. Conclusions : These preliminary results show that this new method of intra-ductal tumour destruction by high intensity US is feasible during standard ERCP and induces tumour necrosis with inflammatory response. Follow-up will determine if this method can be curative in some cases and reduce the need for biliary stenting.