English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

An 83-year-old woman presented with recurrent hemosuccus pancreaticus. The patient had previously undergone a distal pancreatic resection due to intrapapillary mucinous neoplasm, with main duct involvement of the tail. Upper endoscopy revealed active bleeding through the ampulla of Vater. During a previous episode of pancreatic bleeding, intraductal injection of fibrin glue had been performed. Endoscopic retrograde pancreatography demonstrated dilated pancreatic ducts of the remnant pancreatic head. Approximately 3cm above the papilla, the main pancreatic duct showed a 10-mm-long irregular stricture (●" Fig.1). As the patient refused surgical treatment, radiofrequency ablation (RFA) was performed using a bipolar RFA catheter (EndoHPB; EMcision, Montreal, Canada) designed for biliary RFA. The RFA catheter was advanced over a 0.035-inch guidewire (Jagwire; Boston Scientific Corp., Natick, Massachusetts, USA) (●" Fig.2). RFA was applied for a total of 90 seconds using 8W soft coagulation mode, effect 1 (ERBE VIO 300 D; ERBE Elektromedizin GmbH, Tübingen, Germany). The patient developed mild pancreatitis following RFA, with a maximum serum lipase of 9.6μmol/L after 12hours,which returned tonormalwithin 24 hours. Computed tomography scan 2 days after ablation showed a 20-mm cystic ablation area in the pancreatic head (●" Fig.3). The patient developed no further bleeding during 10 weeks of followup. Whereas endoscopic ultrasound-guided RFA is under evaluation for the ablation of pancreatic lesions, we are not aware of any previous case of direct intraductal application of RFA [1]. Intraductal RFA has the potential to treat complications of intraductal tumor growth such as bleeding. Bleeding from the pancreatic duct often requires radiological or surgical intervention [2]. In the present case, RFAwas used to treat bleeding. However, RFA may also be a treatment option for the treatment of small intraductal neoplasms. At present, intraductal RFA is approved for the treatment of malignant biliary strictures [3] and is an alternative to photodynamic therapy [4]. Fig.2 Radiofrequency ablation probe positioned in the stenosis during ablation. Fig.3 Computed tomography scan 2 days after radiofrequency ablation, showing a hypodense lesion in the pancreatic head, corresponding to the ablation area. Fig.1 Pancreatic duct system in the head with visible stenosis caused by the bleeding tumor. Cases and Techniques Library (CTL) E489

Endoscopic intraductal radiofrequency ablation of remnant intrapapillary mucinous neoplasm with acute hemorrhage after incomplete surgical resection