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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(03): E440-E447
DOI: 10.1055/a-2226-0928
Original article

Radiofrequency ablation for ampullary neoplasia with intraductal extension after endoscopic papillectomy: Systematic review and meta-analysis

Davi Lucena Landim
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
,
Diogo Turiani Hourneaux de Moura 
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
,
Bruno Salomao Hirsch 
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
,
Guilherme Henrique Peixoto de Oliveira
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
,
Matheus de Oliveira Veras
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
,
Felipe Giacobo Nunes
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
,
Paulo Ricardo Pavanatto Cavassola
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
,
Wanderley Marques Bernardo
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
,
Sultan Mahmood
2   Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States (Ringgold ID: RIN1811)
,
Eduardo Guimarães Hourneaux de Moura
1   Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil (Ringgold ID: RIN28133)
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Abstract

Background and study aims Noninvasive ampullary neoplasms may be removed by surgery or endoscopy. However, given the morbidity and mortality associated with surgery, endoscopic papillectomy (EP) is the preferred approach. Radiofrequency ablation (RFA) after EP has emerged as a promising alternative therapy to avoid surgery after incomplete EP. Our goal was to evaluate the efficacy and safety of RFA for residual or recurrent lesions with intraductal extension after endoscopic papillectomy.

Patients and methods The inclusion criteria include clinical trials, cohort studies, and case series evaluating patients with residual or recurrent lesions with intraductal extension after EP treated with RFA. Case reports, duplicated data, and studies with follow-up periods < 10 months were excluded. The metanalysis evaluated adverse events, surgical conversion rate, clinical success and recurrence.

Results Seven studies were selected, totaling 124 patients. RFA was associated with a clinical success rate of 75.7% (95% confidence interval [CI] 65.0-88.0%; I2 = 23.484) in a mean follow-up period < 10 months. However, the biliary stricture rate was 22.2% (95% CI 12.1-28.4%; I2 = 61.030), 14.3% of pancreatitis (95% CI 8.8-22.3%; I2 < 0.001), 7.0% of cholangitis (95% CI 3.3-14.5%; I2 < 0.001), 4.0% of bleeding (95% CI 1.7-9.3%; I2 < 0.001), and recurrence of 24.3% (95% CI 16.0-35.0%; I2 = 23.484).

Conclusions RFA is feasible and appears to be effective for managing residual or recurrent lesions with intraductal extension after EP. However, long-term follow-up and high-quality studies are required to confirm our findings.

Keywords

RFA and ablative methods - Strictures - Endoscopy Upper GI Tract - Pancreatobiliary (ERCP/PTCD)


Publication History

Received: 20 July 2023

Accepted after revision: 06 December 2023

Accepted Manuscript online:
11 December 2023

Article published online:
28 March 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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