Subscribe to RSS
DOI: 10.1055/a-2204-8316
Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis
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.
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/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Adler D, Byrne K. Endoscopic stenting for malignant biliary obstruction. Post TW, ed UpToDate Waltham, MA: UpToDate Inc. Accessed March 05, 2023 at: https://www.uptodate.com
- 2 Chandrasekar VT, Faigel D. Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting. Mini-invasive Surgery 2021;
- 3 Canakis A, Kahaleh M. Endoscopic palliation of malignant biliary obstruction. World J Gastrointest Endosc 2022; 14: 581-596
- 4 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
- 5 Zorrón Pu L, De Moura EGH, Bernardo WM. et al. Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis. World J Gastroenterol 2015; 21: 13374-13385
- 6 Yan X, Zou H, Lai Y. et al. Efficacy and safety of first-line targeted treatment and immunotherapy for patients with biliary tract cancer: a systematic review and meta-analysis. Cancers (Basel) 2022; 15: 39
- 7 Weismüller TJ. Role of intraductal RFA: a novel tool in the palliative care of perihilar cholangiocarcinoma. Visc Med 2021; 37: 39-47
- 8 Inoue T, Yoneda M. Updated evidence on the clinical impact of endoscopic radiofrequency ablation in the treatment of malignant biliary obstruction. Digest Endosc 2022; 34: 345-358
- 9 Sharaiha RZ, Natov N, Glockenberg KS. et al. Comparison of metal stenting with radiofrequency ablation versus stenting alone for treating malignant biliary strictures: Is there an added benefit?. Dig Dis Sci 2014; 59: 3099-310
- 10 Liang H, Peng Z, Cao L. et al. Metal stenting with or without endobiliary radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma. J Cancer Ther 2015; 06: 981-992
- 11 Oh D, Chong J, Song TJ. et al. The usefulness of endobiliary radiofrequency ablation before metal stent placement in unresectable malignant hilar obstruction. J Gastroenter Hepatol (Australia) 2022;
- 12 Xia MX, Wang SP, Yuan JG. et al. Effect of endoscopic radiofrequency ablation on the survival of patients with inoperable malignant biliary strictures: A large cohort study. J Hepatobiliary Pancreat Sci 2022; 29: 693-702
- 13 Inoue T, Naitoh I, Kitano R. et al. Endobiliary radiofrequency ablation combined with gemcitabine and cisplatin in patients with unresectable extrahepatic cholangiocarcinoma. Curr Oncology 2022; 29: 2240-2251
- 14 Qumseya BJ, Jamil LH, Elmunzer BJ. et al. ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction. Gastrointest Endosc 2021; 94: 222-234.e22
- 15 Nakai Y, Isayama H, Wang HP. et al. International consensus statements for endoscopic management of distal biliary stricture. J Gastroenterol Hepatol (Australia) 2020; 35: 967-979
- 16 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Revista Espanola de Nutricion Humana y Dietetica 2016; 20: 148-160
- 17 GRADEpro GDT: GRADEpro Guideline Development Tool Software. McMaster University and Evidence Prime, 2023. Accessed January 01, 2000 at: https://gradepro.org
- 18 The Cochrane Collaboration. Review Manager (RevMan) Computer program. Version 5.4. 2020
- 19 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
- 20 Kang H, Chung MJ, Cho IR. et al. Efficacy and safety of palliative endobiliary radiofrequency ablation using a novel temperature-controlled catheter for malignant biliary stricture: a single-center prospective randomized phase II TRIAL. Surg Endosc 2021; 35: 63-73
- 21 Gao DJ, Yang JF, Ma SR. et al. Endoscopic radiofrequency ablation plus plastic stent placement versus stent placement alone for unresectable extrahepatic biliary cancer: a multicenter randomized controlled trial. Gastrointest Endosc 2021; 94: 91-100.e2
- 22 Andrasina T, Rohan T, Panek J. et al. The combination of endoluminal radiofrequency ablation and metal stent implantation for the treatment of malignant biliary stenosis - Randomized study. Eur J Radiol 2021; 142
- 23 Kang H, Han SY, Cho JH. et al. Efficacy and safety of temperature-controlled intraductal radiofrequency ablation in advanced malignant hilar biliary obstruction: A pilot multicenter randomized comparative trial. J Hepatobiliary Pancreat Sci 2022; 29: 469-478
- 24 Albers D, Schmidt A, Schiemer M. et al. Impact of endobiliary radiofrequency ablation on biliary drainage in patients with malignant biliary strictures treated with uncovered self-expandable metal stents: a randomized controlled multicenter trial. Gastrointest Endosc 2022;
- 25 Hu B, Gao D-J, Zhang X. et al. 21 Endobiliary radiofrequency ablation improve overall survival of cholangiocarcinoma: a multi-center randomized control study. Gastrointest Endosc 2016; 83: AB126
- 26 Yang J, Wang J, Zhou H. et al. Endoscopic radiofrequency ablation plus a novel oral 5-fluorouracil compound versus radiofrequency ablation alone for unresectable extrahepatic cholangiocarcinoma. Gastrointest Endosc 2020; 92: 1204-1212.e1
- 27 Cha BH, Jang MJ, Lee SH. Survival benefit of intraductal radiofrequency ablation for malignant biliary obstruction: A systematic review with meta-analysis. Clin Endosc 2021; 54: 100-106
- 28 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.e1
- 29 Song S, Jin H, Cheng Q. et al. Local palliative therapies for unresectable malignant biliary obstruction: radiofrequency ablation combined with stent or biliary stent alone? An updated meta-analysis of nineteen trials. Surg Endosc 2022; 36: 5559-5570
- 30 Khizar H, Hu Y, Wu Y. et al. Efficacy and safety of radiofrequency ablation plus stent versus stent-alone treatments for malignant biliary strictures. J Clin Gastroenterol 2023; 57: 335-345
- 31 Zheng X, Bo ZY, Wan W. et al. Endoscopic radiofrequency ablation may be preferable in the management of malignant biliary obstruction: A systematic review and meta-analysis. J Dig Dis 2016; 17: 716-724
- 32 Kanno Y, Ito K, Nakahara K. et al. Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: A multicenter randomized trial. Gastrointest Endosc 2023;
- 33 Kovács N, Pécsi D, Sipos Z. et al. Suprapapillary biliary stents have longer patency times than transpapillary stents – a systematic review and meta-analysis. J Clin Med 2023; 12: 898