Usefulness of intraductal RFA in patients with malignant biliary obstructionopen access
- Authors
- Han, Sung Yong; Kim, Dong Uk; Kang, Dae Hwan; Baek, Dong Hoon; Lee, Tae Hoon; Cho, Jae Hee
- Issue Date
- 14-Aug-2020
- Publisher
- Lippincott Williams & Wilkins Ltd.
- Keywords
- biliary tract cancer; ERCP; radiofrequency ablation; perihilar cholangiocarcinoma; self-expandable metallic stents
- Citation
- Medicine, v.99, no.33
- Journal Title
- Medicine
- Volume
- 99
- Number
- 33
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/2547
- DOI
- 10.1097/MD.0000000000021724
- ISSN
- 0025-7974
1536-5964
- Abstract
- Background/Aims: Intraductal radiofrequency ablation (ID-RFA) is a novel therapy for unresectable malignant biliary obstructions. ID-RFA for perihilar lesions is associated with a high risk of adverse events. We aimed to evaluate the feasibility and efficacy of temperature-controlled ID-RFA for perihilar malignant biliary obstruction. Methods: Sixteen patients with pathologically proven perihilar cholangiocarcinoma were prospectively enrolled to evaluate the feasibility of hilar ID-RFA. Clinical efficacy and outcomes were subsequently evaluated in a multicenter retrospective cohort. Results: Nine of the 16 patients in the prospective cohort had Bismuth type IV and 7 had type IIIA perihilar cholangiocarcinoma. The median length of stricture was 34.5 mm. The median number of ID-RFA sessions was three, and all sessions were technically and functionally successful without severe adverse events. Clinical outcomes were assessed using a multicenter hilar ID-RFA cohort of 21 patients; the median stent patency and overall survival were 90 days (range: 35-483 days) and 147 days (range: 92-487 days), respectively. An approximate 16-month patency of the bile duct was maintained in one patient who had an intraductal growth pattern. In a comparison of the self-expandable metallic stent (SEMS) and plastic stent (PS) after hilar ID-RFA, no differences in stent patency (89 vs 90.5 days, respectively;P = .912) and adverse events (20.0% vs 10%, respectively;P = .739) were observed. Conclusions: ID-RFA at 7 W for 120 seconds is safe and feasible in patients with advanced perihilar cholangiocarcinoma. After ID-RFA, SEMS and PS placement showed comparable patency and survival rates.
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