Intraductal and ultrasound-guided tissue ablation in the biliary tract and the pancreas : potential and limitations of endoscopic techniques

Endoscopic tissue ablation can be achieved by two distinct endoscopic methods : photodynamic therapy (PDT) and radiofrequency ablation (RFA). ERCP-guided intraductal ablation can be used in patients with non operable extrahepatic cholangiocarcinoma or with an intraductal extension of an ampullary tumor. We will see that PDT needs improvements before being considered again for routine use, and that RFA is the ablation method of choice in 2022, despite an uncertain efficacy on stent patency. Suggested survival improvement needs confirmation by high quality randomized studies. Although the real value of ablation remains difficult to assess when patients receive concurring therapies, the demonstration of a local response par cholangioscopy could help validate this method. EUS-guided ablation may be valuable in benign of pancreatic tumors, especially insulinoma, whereas its value in pancreatic cancer remains to be investigated.
Key words : radiofrequency, PDT, endoscopy-guided ablation