Abstract No. 22 Management of Inoperable Pancreatic Cancer by Percutaneous Image-Guided Biliary and Pancreatic Duct Recanalization

Pancreatic duct (PD) stricture and upstream duct dilation are common consequences of pancreatic head cancer, often leading to issues with fat digestion, pancreatitis, and diabetes associated with pancreatic atrophy. This study aims to introduce an innovative technique for pancreatic duct recanalization. With institutional review board approval and HIPAA compliance, 38 patients with inoperable pancreatic head cancer underwent a percutaneous endoluminal radiofrequency (EL-RFA) treatment, followed by the implantation of a metal stent after an initial percutaneous drainage of the main PD. A guidewire was passed through the obstructed segment of the PD using the existing drainage fistula. A bipolar endoluminal RF device (Habib EndoHPB, EMcision Ltd., London, UK) was placed within the blocked PD segment, applying 15 Watts of power for 2 minutes over the guidewire. Following RF ablation, a self-expandable metal stent with a diameter ranging from 6 to 10 mm was immediately implanted, and the restoration of PD patency was confirmed through contrast injection. The procedure was finalized with the repositioning of the drainage catheter. One (2.6%, 1/38) case had a complete technical failure due to wire conduction failure, and the procedure was technically successful in 37 (97.4%, 37/38) cases. No major complications were encountered; although 6 (16%, 6/37) cases had electrolyte imbalance, which required the administration of intravenous resuscitation for their management. Among the 37 completed cases, biliary recanalization was also performed using the same technique, prior to the PD procedure in 32 (86.5%, 32/37) cases, post-PD procedure in 4 (10.8%, 4/37) cases, and simultaneously in 1 (2.7%, 1/37) case. PD recanalization was performed without biliary intervention only in two patients with previous biliary surgical anastomosis. Lifelong restoration of PD patency without any episodes of pancreatitis was achieved in all technical success 37 (100%, 37/37) cases. Percutaneous recanalization of malignant pancreatic duct strictures through endoluminal radiofrequency and stenting, utilizing percutaneous drainage fistula, is a safe and effective technique. However, further trials are needed to investigate the potential safety and effectiveness of this technique.