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DOI: 10.1055/a-1133-4448
Endobiliary radiofrequency ablation combined with bilateral metal stent placement for malignant hilar biliary obstruction
TRIAL REGISTRATION: Single-center observational study UMIN000033458 at http://www.umin.ac.jp![](https://www.thieme-connect.de/media/endoscopy/202007/lookinside/thumbnails/18628_10-1055-a-1133-4448-1.jpg)
Abstract
Background The effectiveness of endobiliary radiofrequency ablation (RFA) is still uncertain, especially in patients with malignant hilar biliary obstruction (MHBO). We examined the efficacy of endobiliary RFA followed by bilateral self-expandable metal stent (SEMS) placement for unresectable MHBO.
Methods 41 patients met the eligibility criteria for study inclusion. We evaluated the technical success, functional success, and recurrent biliary obstruction (RBO) associated with RFA with bilateral SEMS placement.
Results The technical and functional success rates were both 95.1 % (39/41). The RBO rate was 38.5 % (15/39), and the median time to RBO was 230 days. Stricture length was positively correlated with time to RBO in the multivariate analysis (P = 0.03). The median time to RBO was significantly longer in patients with strictures > 15 mm in length than in those with strictures ≤ 15 mm (314 vs. 156 days; P = 0.02).
Conclusions The present study showed that endobiliary RFA with bilateral SEMS placement achieved good results, but selection of patients with an appropriate stricture length may be needed to obtain a sufficient ablative effect.
Publication History
Received: 20 December 2019
Accepted: 17 February 2020
Article published online:
24 March 2020
© Georg Thieme Verlag KG
Stuttgart · New York
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References
- 1 Yang J, Wang J, Zhou H. et al. Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial. Endoscopy 2018; 50: 751-760
- 2 Cui W, Wang Y, Fan W. et al. Comparison of intraluminal radiofrequency ablation and stents vs. stents alone in the management of malignant biliary obstruction. Int J Hyperthermia 2017; 33: 853-861
- 3 Larghi A, Rimbaş M, Tringali A. et al. Endoscopic radiofrequency biliary ablation treatment: a comprehensive review. Dig Endosc 2019; 31: 245-255
- 4 Sofi AA, Khan MA, Das A. et al. Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 2018; 87: 944-951
- 5 Ortner ME, Caca K, Berr F. et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 2003; 125: 1355-1363
- 6 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – updated October 2017. Endoscopy 2018; 50: 910-930
- 7 Inoue T, Ishii N, Kobayashi Y. et al. Simultaneous versus sequential side-by-side bilateral metal stent placement for malignant hilar biliary obstructions. Dig Dis Sci 2017; 62: 2542-2549
- 8 Isayama H, Hamada T, Yasuda I. et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc 2015; 27: 259-264
- 9 Lee YN, Jeong S, Choi HJ. et al. The safety of newly developed automatic temperature-controlled endobiliary radiofrequency ablation system for malignant biliary strictures: a prospective multicenter study. J Gastroenterol Hepatol 2019; 34: 1454-1459