Korean J Gastroenterol.  2020 Jan;75(1):50-55. 10.4166/kjg.2020.75.1.50.

Palliative Measures with Ethanol Gallbladder Ablation and Endobiliary Radiofrequency Ablation Followed by Endoscopic Biliary Stent Placement in an Advanced Case of Common Bile Duct Cancer: A Case Report

  • 1Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. minky1973@hanmail.net
  • 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
  • 3Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea.


Endobiliary radiofrequency ablation (RFA) is a procedure performed widely to induce locoregional tumor control by the transfer of thermal energy to the lesion and subsequent tumor necrosis. A 72-year-old male with a prior history of acute calculous cholangitis and perforated cholecystitis was admitted to the Kyungpook National University Hospital complaining of fever and nausea. He had an indwelling percutaneous transhepatic gallbladder drainage (PTGBD) catheter from the previous episode of perforated cholecystitis. An abdominal CT scan showed marked dilation of both the intrahepatic and extrahepatic bile ducts. Common bile duct cancer was confirmed histologically after an endobiliary biopsy. A surgical resection was considered to be the initial treatment option. During open surgery, multiple metastatic nodules were present in the small bowel mesentery and anterior abdominal wall. Resection of the tumor was not feasible, so endobiliary RFA was performed prior to biliary stenting. Cholecystectomy was required for the removal of the PTGBD catheter, but the surgical procedure could not be performed due to a cystic ductal invasion of the tumor. Instead, chemical ablation of the gallbladder (GB) with pure ethanol was performed to breakdown the GB mucosa. Palliative treatment for a biliary obstruction was achieved successfully using these procedures. In addition, a PTGBD catheter was removed successfully without significant side effects. As a result, an improvement in the patient's quality of life was accomplished.


Gallbladder; Radiofrequency ablation; Cholangiocarcinoma; Cholangiopancreatography, endoscopic retrograde

MeSH Terms

Abdominal Wall
Bile Ducts, Extrahepatic
Catheter Ablation*
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct*
Cystic Duct
Mucous Membrane
Palliative Care
Quality of Life
Tomography, X-Ray Computed


  • Fig. 1 Abdominal computed tomography scan showed a perforated gallbladder and abscesses at lesser sac and ligament teres, which is suspicious for acute perforated cholecystitis, diffusely thickened common bile duct and intrahepatic duct dilatation with a stricture.

  • Fig. 2 Endobiliary radiofrequency ablation was performed under seven watts using the 22 mm RFA catheter (ELRA® RF catheter, STARmed, Goyang, Korea) for 2 minutes. The arrows indicate the RFA catheter electrode. The partially covered biliary stent was placed through the narrowed common bile duct after performing the endobiliary radiofrequency ablation.

  • Fig. 3 (A–D) PTBD was removed successfully after endobiliary radiofrequency ablation followed by biliary stent placement. PTGBD was also removed after chemical ablation of the gallbladder using ethanol. PTBD, percutaneous transhepatic biliary drainage; PTGBD, percutaneous transhepatic gallbladder drainage.

  • Fig. 4 Two cycles of chemical ablation of the gallbladder using 5 mL of pure ethanol at one-week intervals were performed to remove percutaneous transhepatic gallbladder drainage catheter.


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