Intraductal temperature-controlled radiofrequency ablation in malignant hilar obstruction: a preliminary study in animals and initial human experience

Eui Joo Kim; Jae Hee Cho; Yoon Jae Kim; Tae Hoon Lee; Joon Mee Kim; Seok Jeong; Yeon Suk Kim

doi:10.1055/a-0970-9005

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(10): E1293-E1300
DOI: 10.1055/a-0970-9005

Original article

Intraductal temperature-controlled radiofrequency ablation in malignant hilar obstruction: a preliminary study in animals and initial human experience

Authors

Eui Joo Kim

¹Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
Jae Hee Cho

¹Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
Yoon Jae Kim

¹Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
Tae Hoon Lee

²Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
Joon Mee Kim

³Department of Pathology, Inha University School of Medicine, Incheon, Republic of Korea
Seok Jeong

⁴Department of Gastroenterology and Hepatology, and the National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), Inha University School of Medicine, Incheon, Republic of Korea
Yeon Suk Kim

¹Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea

Abstract

Background and study aims Intraductal radiofrequency ablation (ID-RFA) is a recently developed method widely used for treatment of malignant extrahepatic biliary tract obstructions. However, its safety in hilar application has yet to be clearly demonstrated. The aim of this study was to evaluate the safety of ID-RFA in the treatment of malignant hilar obstruction.

Patients and methods Endoscopic retrograde cholangiography followed by temperature-controlled ID-RFA at the hilar area using different probe lengths (11, 18, and 22 mm) and settings (7 or 10 W for 60 – 120 s) was performed in six mini-pigs. In addition, patients with malignant hilar obstruction who underwent palliative ID-RFA were retrospectively evaluated.

Results In the animal study using different ID-RFA settings, post-ID-RFA fluoroscopic radiocontrast leakage and microscopic bile duct perforation with hepatic abscess were observed in four of the six mini-pigs. Only two of the them, in which an 11-mm ID-RFA probe at a target temperature of 80 °C, power of 7 W, and duration of 60 s was used, underwent successful ID-RFA without any immediate adverse events (AEs). Clinically, ID-RFA was performed using the 11-mm probe with the setting of 80 °C, 7 W, and 60 – 120 s for malignant hilar obstruction, and total of 11 patients underwent successful ID-RFA without AEs.

Conclusions Our study suggests that ID-RFA performed using a short-length probe with settings of 80 °C, 7 W and 60 – 120 s is a safe and feasible palliative treatment for malignant hilar obstruction.

Full Text

References

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