Habib™ EndoHPB
Dr David Westaby Consultant Gastroenterologist Hammersmith Hospital Imperial College Healthcare NHS Trust London UK
Malignant Bile Duct Obstruction
Pancreatic Cancer Cholangiocarcinoma Gallbladder carcinoma Metastatic Disease
Intrahepatic Extrahepatic
Malignant Bile Duct Obstruction
75-80% carcinoma head of pancreas 15-20% considered for currative surgery The majority managed by :Stenting Chemotherapy
Malignant Bile Duct Obstruction
Plastic Stents Self Expanding Metal Stents
Patency of Metal Stents for Malignant Bile Duct Obstruction
100% 80% 60% 40% 20%
Patency
0%
0 100 200 300 400 500
Days
Cumulative Patency of the First Stent Metal Stent Polyethylene Stent p=0.006
Consequences of Early Stent Occlusion
Cholangitis
Excacerbated by chemotherapy related neutropaenia
Delayed /Modified Chemotherapy Associated Significant Morbidity and Mortality Cost Implications
Habib™ EndoHPB
• • • • • • • Single use 1.8m length 8Fr (2.6mm) 0.035inch guidewire 3.2mm working channel Bipolar Two stainless steel ring electrodes 8mm apart • Heating zone 25mm +/-3mm
EndoHPB presentation in dispenser coil
5
Distal electrode
Close up of EndoHPB showing the two spiral cut electrodes, 8mm spacing, with the distal electrode 5mm from tip
Technique
Insertion of guidewire through the Ampulla of Vater
Following fluoroscopy and assessment of length of duct obstruction the EndoHPB is inserted to the upper part of the tumour Probe activation with 10 Watts for 2 minutes. This causes tissue ablation length 2.5cm and width of 0.5cm This can be repeated once or twice according to the length of the tumour A metal stent is inserted following removal of the RF probe
Habib EndoHPB RF Catheter
RF probe inserted into CBD
Metal stent in right hepatic duct following RF activation
RFA for Pancreatic Head Adenocarcinoma
Cholangiogram showing lower CBD stricture in a patient with pancreatic adenocarcinoma
RF probe across the stricture
Pre Ablation
Ultrasound demonstrating RF probe in the CBD prior to RF activation
Post Ablation
Following RF activation increased signal intensity due to tumour ablation
RFA for Ampullary Adenocarcinoma
RF ablation for ampullary adenocarcinoma with the probe across the tumour
Metal stent in situ post RF ablation
RFA for Hilar Cholangiocarcinoma
RF probe in segment 8 duct
RF probe in segment 5 duct
RFA for Hilar Cholangiocarcinoma
Metal stents in segment 5 and segment 8 following RF ablation
RFA for Stent Occlusion
RF probe in occluded metal stent
Post ablation second metal stent inserted through the old stent