ORIGINAL ARTICLE Radiofrequency ablation for intraductal extension of ampullary neoplasms Tarun Rustagi, MD, 1 Shayan Irani, MD, 2 D. Nageshwar Reddy, MD, 3 Barham K. Abu Dayyeh, MD, MPH, 1 Todd H. Baron, MD, 4 Christopher J. Gostout, MD, 1 Michael J. Levy, MD, 1 John Martin, MD, 1 Bret T. Petersen, MD, 1 Andrew Ross, MD, 2 Mark D. Topazian, MD 1 Rochester, Minnesota; Seattle, Washington; Chapel Hill, North Carolina, USA; Hyderabad, India Background and Aims: Extension of ampullary adenomas into the common bile duct (CBD) or pancreatic duct (PD) may be difficult to treat endoscopically. We evaluated the feasibility, safety, and efficacy of endoscopic radio- frequency ablation (RFA) in the management of ampullary neoplasms with intraductal extension. Methods: This was a multicenter, retrospective analysis of all patients with intraductal extension of ampullary neoplasms treated with endoscopic RFA between February 2012 and June 2015. Treatment success was defined as the absence of detectable intraductal polyps by ductography, visual inspection, and biopsy sampling. Results: Fourteen patients with adenoma extension into the CBD (13  7 mm, n Z 14) and PD (7  2 mm, n Z 3) underwent a median of 1 RFA sessions (range, 1-5). Additional modalities (thermal probes, argon plasma coagulation, and/or photodynamic therapy) were also used in 7 patients, and prophylactic stents were routinely placed. Thirteen assessable patients underwent a median of 2 surveillance ERCPs after completion of treatment over a median follow-up of 16 months (range, 5-46), with intraductal biopsy specimens showing no neoplasm in 12 patients at the conclusion of endoscopic treatment. Treatment success was achieved in 92%, including 100% of those treated with RFA alone. Adverse events occurred in 43% and included ductal strictures (5 patients) and retroduodenal abscess (1 patient), all of which were successfully treated endoscopically. Conclusions: Endoscopic RFA, alone or in combination with other modalities, may effectively treat intraductal extension of ampullary neoplasms. Ductal strictures were common after RFA but responded to endoscopic stent therapy. RFA may be appropriate in selected patients, particularly when the main treatment alternative is pancrea- ticoduodenectomy. (Gastrointest Endosc 2016;-:1-7.) Ampullary adenomas are the most common ampullary tumors and are increasingly detected because of the wide- spread use of upper GI endoscopy and CT. 1,2 Complete resection of ampullary adenomas is advised because they are premalignant lesions that may undergo malignant trans- formation through the adenoma–carcinoma sequence. 3 Currently, endoscopic papillectomy is a preferred approach for management of ampullary adenomas not known to contain invasive cancer. Intraductal extension of ampullary adenomas into the common bile duct (CBD) or pancreatic duct (PD) is challenging to treat endoscopically and may be considered a contraindication to endoscopic therapy. 4-7 Intraductal biliary radiofrequency ablation (RFA) is an ablative therapy that has been used to treat malignant biliary strictures and tumor ingrowth into biliary self-expandable metal stents. 8-12 The aim of this study was to evaluate the feasibility, safety, and efficacy of endoscopic RFA in the management of ampullary neoplasms with intra- ductal extension. Abbreviations: APC, argon plasma coagulation ablation; CBD, common bile duct; PD, pancreatic duct; RFA, radiofrequency ablation. DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. Copyright ª 2016 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 http://dx.doi.org/10.1016/j.gie.2016.11.002 Received May 26, 2016. Accepted November 2, 2016. Current affiliations: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA (1), Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA (2), Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India (3), Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA (4). Reprint requests: Mark D. Topazian, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. If you would like to chat with an author of this article, you may contact Dr Topazian at topazian.mark@mayo.edu www.giejournal.org Volume -, No. - : 2016 GASTROINTESTINAL ENDOSCOPY 1