Endoscopic Radiofrequency Ablation Combined with Metal Stent Placement for Malignant Biliary Stricture.

Malignant biliary strictures (MBS) are a challenging clinical issue with limited therapeutic options for unresectable cases. This protocol establishes a standardized minimally invasive approach of endoscopically-guided biliary radiofrequency ablation (RFA) combined with self-expandable metal stent (SEMS) placement via endoscopic retrograde cholangiopancreatography (ERCP) for MBS. The core workflow includes preoperative preparation, endoscopic exploration and cholangiography, direct cholangioscopic assessment, targeted RFA of the stenotic segment, SEMS deployment, and postoperative management and follow-up. Key procedural parameters are defined: bipolar RFA at 8 W for 90-120 s, and placement of a covered SEMS (CSEMS) with 1 cm extension beyond the stenosis margins. Clinical application in a representative case achieved rapid resolution of jaundice (70% reduction in total bilirubin at 5 days post-procedure) and technical success with unobstructed biliary patency at 1 month. The procedure has a favorable safety profile, with no major acute complications observed in the case. This standardized protocol provides a reproducible method for clinical practitioners, and the combined technique offers a valuable palliative option for unresectable MBS by prolonging stent patency and alleviating biliary obstruction symptoms. Further multicenter trials are needed to validate its long-term efficacy in larger patient cohorts.