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An 82-year-old man was referred for exploration and treatment of a stenosis of the main pancreatic duct that was found incidentally during a computed tomography (CT) scan. He reported no symptoms. Endoscopic ultrasonography (EUS) showed an 8-mm intraductal nodule in the pancreatic isthmus (▶Fig. 1), with upstream dilatation of the main pancreatic duct, a pancreas divisum, and a gaping minor papilla. Endoscopic retrograde cholangiopancreatography (ERCP)-guided brush cytology and EUS-guided biopsy found an intraductal papillary mucinous neoplasia (IPMN) with dysplasia (▶Fig. 2). Sphincterotomy was performed and a 7-Fr plastic stent was inserted through the minor papilla. Pancreatic resection was deemed inadvisable given the patient’s age and comorbid conditions. After multidisciplinary team discussion, intraductal radiofrequency ablation (RFA) was offered 2 months later (▶Video1). A Habib endo-HPB RFA probe (EMcision Ltd, London, UK) was inserted into the dorsal pancreatic duct over a guidewire (▶Fig. 3) with the two electrodes straddling the mural nodule. RFA was applied for 60 seconds (power 10W, effect 8) ▶ Fig. 1 Endoscopic ultrasonography view of a tissue nodule protruding into the main pancreatic duct. ▶ Fig. 2 Endoscopic retrograde cholangiopancreatography view of a small pancreatic duct stricture with upstream pancreatic duct dilatation.

Intraductal radiofrequency ablation of an intraductal papillary mucinous neoplasia of the main pancreatic duct