Experience in the use of intraductal radiofrequency ablation for adenomas of the major duodenal papilla with intraductal spread

Abstract

Background. Due to the high risk of malignancy, all adenomas of the major duodenal papilla, regardless of morphological structure, must be removed. Currently, the method of choice for adenomas of the major duodenal papilla is endoscopic surgery, with neoplasms of the major duodenal papilla with intraductal spread (types III and IV according to the endoscopic classification of neoplasms of the major duodenal papilla) representing particular difficulty for endoscopic techniques. The introduction of intraductal radiofrequency ablation into clinical practice provides new opportunities for minimally invasive treatment of patients with adenomas of the major duodenal papilla, including those with extensive spread to the bile and pancreatic ducts. Material and methods. From 2022 to 2024, 14 patients with adenomas of the major duodenal papilla with extension to the common bile and main pancreatic ducts underwent intraductal radiofrequency ablation. The extent of spread of the adenoma to the common bile duct ranged from 10 to 30 mm, to the main pancreatic duct - from 3 to 11 mm. Results. Technical success of intraductal RFA was achieved in all cases. Postoperative complications were noted in 3 cases, in which moderately severe post-manipulation pancreatitis developed. During a follow-up examination after 3-6 months, residual adenomatous growths were detected in 3 patients, which required a repeat session of intraductal RFA. All patients underwent stenting of the main pancreatic duct and the common bile duct was achieved in all cases. Conclusion. Intraductal radiofrequency ablation has opened up the possibility of endoscopic treatment of patients with adenomas of the major duodenal papilla, characterized by extensive spread to the common bile and main pancreatic ducts.