Use of Histotripsy to Rapidly Relieve Biliary Obstruction in a Patient With Recurrent Hilar Cholangiocarcinoma

Hilar cholangiocarcinoma (HCCA) is a rare, aggressive cancer often diagnosed at an unresectable stage. Patients commonly require systemic therapy and biliary stenting to manage symptoms and maintain liver function. Histotripsy is a novel, non-invasive, mechanical ablation technique recently FDA-approved for liver tumors. We report the case of a 77-year-old woman with recurrent HCCA who experienced progressive biliary obstruction despite chemotherapy and irreversible electroporation. She underwent 2 staged histotripsy treatments targeting tumors in the left and right biliary systems. Procedures were well-tolerated, with no complications, and led to normalization of bilirubin within 72 hours. Imaging at 6 months showed stable disease and sustained biliary patency, with only 1 stent exchange needed. This case highlights the potential role of histotripsy in relieving biliary obstruction and controlling local disease in patients with HCCA.