CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(01): E23-E33
DOI: 10.1055/a-2204-8316
Review

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Diogo Turiani Hourneaux de Moura
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
2   Internal Medicine, Yale University School of Medicine, New Haven, United States (Ringgold ID: RIN12228)
,
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Rômulo Sérgio Araújo Gomes
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Davi Lucena Landim
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Felipe Giacobo Nunes
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Tomazo Antônio Prince Franzini
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Wanderley Marques Bernardo
3   Gastroenterology, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Eduardo Guimarães Hourneaux de Moura
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
› Author Affiliations
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Abstract

Background and study aims Recurrent biliary stent occlusion and tumor ingrowth remain a major concern among patients with malignant biliary obstruction (MBO) with significant impact on patient morbidity and survival. Intraductal radiofrequency ablation (RFA) has emerged as a promising treatment that seeks to extend stent patency. This study aimed to evaluate the impact of RFA on overall survival (OS) and stent patency among patients with unresectable MBO.

Methods A comprehensive search of electronic databases was performed for randomized controlled trials (RCTs) comparing RFA plus biliary stent (RFA+S) versus biliary stent alone (S-alone). Outcomes assessed included overall survival, stent patency, and adverse events (AEs) with mean difference (MD) calculated from pooled proportions. Subgroup analyses were performed for hilar strictures and cholangiocarcinoma (CCA).

Results Six RCTs (n=481 patients) were included and demonstrated improved survival among patients who received RFA+S (MD 85.70 days , 95% confidence interval [CI] 34.29–137.10; I2=98%; P =0.001). The pooled MD for total stent patency was 22.25 days (95% CI –17.38–61.87; I2=97%; P=0.27). There was no difference in AEs between RFA+S vs S-alone (P >0.05). On subgroup analyses, RFA+S was associated with improved stent patency (MD 79.25 days; 95% CI 50.77–107.73; I2=59%; P <0.00001) and OS (MD 83.14 (95% CI 29.52–136.77; I2=97%; P <0.01] for CCA. For hilar strictures, stent patency was improved among patients with RFA+S [MD 83.71 days (95% CI 24.85–142.56; I2=84%; P <0.01].

Conclusions RFA+S improved OS in the treatment of MBO when compared with S-alone. Moreover, the RFA therapy prolonged stent patency in hilar strictures and CCA, with similar rates of AEs.

Supplementary Material



Publication History

Received: 30 July 2023

Accepted after revision: 24 October 2023

Accepted Manuscript online:
06 November 2023

Article published online:
05 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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