A 68-year-old woman underwent radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in segment 8 after transcatheter arterial chemoembolization. Pretreatment computed tomography scans revealed that the HCC nodule was adjacent to the intrahepatic B8 bile duct (Figure 1). A 6-Fr endoscopic nasobiliary drainage (ENBD) tube was inserted into the B8 bile duct 1 day before RFA (Figure 2). Before RFA, a perflubutane-based contrast agent (Sonazoid, Daiichi Sankyo, Tokyo, Japan) was injected through the ENBD tube to confirm enhancement of the bile duct adjacent to the HCC nodule (Figure 3). Ultrasonography-guided RFA was performed for the 26 3 33-mm lesion in segment 8 and saline chilled to 4°C was infused into the bile duct through the ENBD tube at a rate of 60 mL/min. Finally, the contrast agent was reinjected through the ENBD tube to confirm enhancement of the peripheral bile duct close to the lesion and absence of bile duct injury (Figure 4). Contrast-enhanced computed tomography scans obtained the day after RFA revealed complete ablation of the HCC lesion with no signs of bile duct injury (Figure 5). | Nội dung Text Radiofrequency ablation for hepatocellular carcinoma adjacent to the bile duct via intraductal cooling through an endoscopic nasobiliary drainage tube
