Usefulness of intraductal RFA in patients with malignant biliary obstruction
- 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. TRIAL REGISTRATION NUMBER: KCT0003223.
- All Author(s)
- S. Y. Han
; D. U. Kim
; D. H. Kang
; D. H. Baek
; T. H. Lee
; J. H. Cho
- Issued Date
- 2020
- Type
- Article
- Keyword
- biliary tract cancer; ERCP; radiofrequency ablation; perihilar cholangiocarcinoma; self-expandable metallic stents
- Publisher
- Lippincott Williams & Wilkins
- ISSN
- 0025-7974
; 1536-5964
- Citation Title
- Medicine
- Citation Volume
- 99
- Citation Number
- 33
- Citation Start Page
- e21724
- Citation End Page
- e21724
- Language(ISO)
- eng
- DOI
- 10.1097/MD.0000000000021724
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/868
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