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Digestive Disease Interventions 2017; 01(01): 036-046
DOI: 10.1055/s-0037-1601378
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Percutaneous Management of Malignant Biliary Strictures: Current Status and Future Directions

Mohammed Attaya
1   Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Hosam Attaya
1   Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Ashraf Thabet
1   Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

15 November 2016

10 February 2017

Publication Date:
30 March 2017 (online)

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Erratum: Percutaneous Management of Malignant Biliary Strictures: Current Status and Future DirectionsDigestive Disease Interventions 2018; 02(04): 402-402
DOI: 10.1055/s-0038-1673635

Abstract

Various minimally invasive percutaneous interventions may be performed for the treatment and management of malignant biliary obstruction. The types of percutaneous interventions include percutaneous transhepatic biliary drainage, percutaneous cholecystostomy, and biliary stent placement. Biliary stents have undergone continued evolution in design to prolong patency, increase cost-effectiveness, improve patient survival, and quality of life. Furthermore, investigational techniques, such as radiofrequency ablation, intraluminal brachytherapy, and photodynamic therapy promise new technologies in the field of biliary intervention. This review focuses on the current status of percutaneous therapies for malignant biliary strictures and obstruction.

Keywords

malignant biliary obstruction - percutaneous interventions - biliary drainage - biliary stents
 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66 (1) 7-30
    CrossrefPubMedGoogle Scholar
  • 2 Lillemoe KD, Pitt HA. Palliation. Surgical and otherwise. Cancer 1996; 78 (3, Suppl): 605-614
    CrossrefPubMedGoogle Scholar
  • 3 Assimakopoulos SF, Scopa CD, Vagianos CE. Pathophysiology of increased intestinal permeability in obstructive jaundice. World J Gastroenterol 2007; 13 (48) 6458-6464
    CrossrefPubMedGoogle Scholar
  • 4 Katz SC, Ryan K, Ahmed N , et al. Obstructive jaundice expands intrahepatic regulatory T cells, which impair liver T lymphocyte function but modulate liver cholestasis and fibrosis. J Immunol 2011; 187 (3) 1150-1156
    CrossrefPubMedGoogle Scholar
  • 5 Castaño R, Lopes TL, Alvarez O, Calvo V, Luz LP, Artifon EL. Nitinol biliary stent versus surgery for palliation of distal malignant biliary obstruction. Surg Endosc 2010; 24 (9) 2092-2098
    CrossrefPubMedGoogle Scholar
  • 6 Dixon JM, Armstrong CP, Duffy SW, Davies GC. Factors affecting morbidity and mortality after surgery for obstructive jaundice: a review of 373 patients. Gut 1983; 24 (9) 845-852
    CrossrefPubMedGoogle Scholar
  • 7 Kloek JJ, van der Gaag NA, Aziz Y , et al. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg 2010; 14 (1) 119-125
    CrossrefPubMedGoogle Scholar
  • 8 Klatskin G. Adenocarcinoma of the Hepatic Duct at Its Bifurcation within the Porta Hepatis. An Unusual Tumor with Distinctive Clinical and Pathological Features. Am J Med 1965; 38: 241-256
    CrossrefPubMedGoogle Scholar
  • 9 Burckhardt H, Muller W. Versuche über die Punktion der Gallenblase und ihre Röntgendarstellung. Deutsche Zeitschrift für Chirurgie 1921; 162 (3) 168-197
    CrossrefPubMedGoogle Scholar
  • 10 Huard P, Hop DX. La ponction transhepatique des canaux biliaires. Bull Soc Med Chir Indochine 1937; 15: 1090-1100
    PubMedGoogle Scholar
  • 11 Oto M, Tsuchiya Y, Ono T, Miki M, Saisho H. Application of percutaneous transhepatic cholangiography in internal medicine [in Japanese]. Nihon Rinsho 1969; 27 (11) 2798-2802
    PubMedGoogle Scholar
  • 12 Boguth L, Tatalovic S, Antonucci F, Heer M, Sulser H, Zollikofer CL. Malignant biliary obstruction: clinical and histopathologic correlation after treatment with self-expanding metal prostheses. Radiology 1994; 192 (3) 669-674
    CrossrefPubMedGoogle Scholar
  • 13 Wagner HJ, Knyrim K, Vakil N, Klose KJ. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy 1993; 25 (3) 213-218
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Kühn JP, Busemann A, Lerch MM, Heidecke CD, Hosten N, Puls R. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. AJR Am J Roentgenol 2010; 195 (4) 851-857
    CrossrefPubMedGoogle Scholar
  • 15 Weber A, Gaa J, Rosca B , et al. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol 2009; 72 (3) 412-417
    CrossrefPubMedGoogle Scholar
  • 16 Harding J, Mortimer A, Kelly M, Loveday E. Interval biliary stent placement via percutaneous ultrasound guided cholecystostomy: another approach to palliative treatment in malignant biliary tract obstruction. Cardiovasc Intervent Radiol 2010; 33 (6) 1262-1265
    CrossrefPubMedGoogle Scholar
  • 17 Yasumoto T, Yokoyama S, Nagaike K. Percutaneous transcholecystic metallic stent placement for malignant obstruction of the common bile duct: preliminary clinical evaluation. J Vasc Interv Radiol 2010; 21 (2) 252-258
    CrossrefPubMedGoogle Scholar
  • 18 Xing GS, Geng JC, Han XW, Dai JH, Wu CY. Endobiliary brush cytology during percutaneous transhepatic cholangiodrainage in patients with obstructive jaundice. Hepatobiliary Pancreat Dis Int 2005; 4 (1) 98-103
    PubMedGoogle Scholar
  • 19 Jung GS, Huh JD, Lee SU, Han BH, Chang HK, Cho YD. Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction. Radiology 2002; 224 (3) 725-730
    CrossrefPubMedGoogle Scholar
  • 20 Tsai CC, Mo LR, Chou CY , et al. Percutaneous transhepatic transluminal forceps biopsy in obstructive jaundice. Hepatogastroenterology 1997; 44 (15) 770-773
    PubMedGoogle Scholar
  • 21 Savader SJ, Prescott CA, Lund GB, Osterman FA. Intraductal biliary biopsy: comparison of three techniques. J Vasc Interv Radiol 1996; 7 (5) 743-750
    CrossrefPubMedGoogle Scholar
  • 22 Rossi M, Cantisani V, Salvatori FM , et al. Histologic assessment of biliary obstruction with different percutaneous endoluminal techniques. BMC Med Imaging 2004; 4 (1) 3
    CrossrefPubMedGoogle Scholar
  • 23 Tapping CR, Byass OR, Cast JE. Cytological sampling versus forceps biopsy during percutaneous transhepatic biliary drainage and analysis of factors predicting success. Cardiovasc Intervent Radiol 2012; 35 (4) 883-889
    CrossrefPubMedGoogle Scholar
  • 24 Kim JY, Choi JH, Kim JH , et al. Clinical usefulness of bile cytology obtained from biliary drainage tube for diagnosing cholangiocarcinoma [in Korean]. Korean J Gastroenterol 2014; 63 (2) 107-113
    CrossrefPubMedGoogle Scholar
  • 25 Hemming AW, Reed AI, Howard RJ , et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg 2003; 237 (5) 686-691 , discussion 691–693
    CrossrefPubMedGoogle Scholar
  • 26 Uhl M, Euringer W, Makowiec F, Adam U, Schneider A, Langer M. Portal vein embolization preparation for major hepatic resection: a new standard in liver surgery [in German]. RoFo Fortschr Geb Rontgenstr Nuklearmed 2007; 179 (1) 31-37
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Galandi D, Schwarzer G, Bassler D, Allgaier HP. Ursodeoxycholic acid and/or antibiotics for prevention of biliary stent occlusion. Cochrane Database Syst Rev 2002; (3) CD003043
    PubMedGoogle Scholar
  • 28 Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340 (8834-8835): 1488-1492
    CrossrefPubMedGoogle Scholar
  • 29 Kaassis M, Boyer J, Dumas R , et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 2003; 57 (2) 178-182
    CrossrefPubMedGoogle Scholar
  • 30 Katsinelos P, Paikos D, Kountouras J , et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness. Surg Endosc 2006; 20 (10) 1587-1593
    CrossrefPubMedGoogle Scholar
  • 31 Knyrim K, Wagner HJ, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 1993; 25 (3) 207-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Soderlund C, Linder S. Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest Endosc 2006; 63 (7) 986-995
    CrossrefPubMedGoogle Scholar
  • 33 Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev 2006; (2) CD004200
    PubMedGoogle Scholar
  • 34 Mukai T, Yasuda I, Nakashima M , et al. Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci 2013; 20 (2) 214-222
    CrossrefPubMedGoogle Scholar
  • 35 Sangchan A, Kongkasame W, Pugkhem A, Jenwitheesuk K, Mairiang P. Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial. Gastrointest Endosc 2012; 76 (1) 93-99
    CrossrefPubMedGoogle Scholar
  • 36 Loew BJ, Howell DA, Sanders MK , et al. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc 2009; 70 (3) 445-453
    CrossrefPubMedGoogle Scholar
  • 37 Lammer J, Hausegger KA, Flückiger F , et al. Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology 1996; 201 (1) 167-172
    CrossrefPubMedGoogle Scholar
  • 38 Isayama H, Kawakubo K, Nakai Y , et al. A novel, fully covered laser-cut nitinol stent with antimigration properties for nonresectable distal malignant biliary obstruction: a multicenter feasibility study. Gut Liver 2013; 7 (6) 725-730
    CrossrefPubMedGoogle Scholar
  • 39 Kitano M, Yamashita Y, Tanaka K , et al. Covered self-expandable metal stents with an anti-migration system improve patency duration without increased complications compared with uncovered stents for distal biliary obstruction caused by pancreatic carcinoma: a randomized multicenter trial. Am J Gastroenterol 2013; 108 (11) 1713-1722
    CrossrefPubMedGoogle Scholar
  • 40 Saleem A, Leggett CL, Murad MH, Baron TH. Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc 2011; 74 (2) 321-327.e1 , 3
    CrossrefPubMedGoogle Scholar
  • 41 Almadi MA, Barkun AN, Martel M. No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: a meta-analysis. Clin Gastroenterol Hepatol 2013; 11 (1) 27-37.e1
    CrossrefPubMedGoogle Scholar
  • 42 Kullman E, Frozanpor F, Söderlund C , et al. Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc 2010; 72 (5) 915-923
    CrossrefPubMedGoogle Scholar
  • 43 Telford JJ, Carr-Locke DL, Baron TH , et al. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc 2010; 72 (5) 907-914
    CrossrefPubMedGoogle Scholar
  • 44 Han YM, Jin GY, Lee SO, Kwak HS, Chung GH. Flared polyurethane-covered self-expandable nitinol stent for malignant biliary obstruction. J Vasc Interv Radiol 2003; 14 (10) 1291-1301
    CrossrefPubMedGoogle Scholar
  • 45 Hausegger KA, Thurnher S, Bodendörfer G , et al. Treatment of malignant biliary obstruction with polyurethane-covered Wallstents. AJR Am J Roentgenol 1998; 170 (2) 403-408
    CrossrefPubMedGoogle Scholar
  • 46 Rossi P, Bezzi M, Salvatori FM, Panzetti C, Rossi M, Pavia G. Clinical experience with covered wallstents for biliary malignancies: 23-month follow-Up. Cardiovasc Intervent Radiol 1997; 20 (6) 441-447
    CrossrefPubMedGoogle Scholar
  • 47 Bezzi M, Zolovkins A, Cantisani V , et al. New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction. J Vasc Interv Radiol 2002; 13 (6) 581-589
    CrossrefPubMedGoogle Scholar
  • 48 Hatzidakis A, Krokidis M, Kalbakis K, Romanos J, Petrakis I, Gourtsoyiannis N. ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease: can tumor ingrowth be prevented?. Cardiovasc Intervent Radiol 2007; 30 (5) 950-958
    CrossrefPubMedGoogle Scholar
  • 49 Schoder M, Rossi P, Uflacker R , et al. Malignant biliary obstruction: treatment with ePTFE-FEP-covered endoprostheses initial technical and clinical experiences in a multicenter trial. Radiology 2002; 225 (1) 35-42
    CrossrefPubMedGoogle Scholar
  • 50 Santerre JP, Labow RS, Duguay DG, Erfle D, Adams GA. Biodegradation evaluation of polyether and polyester-urethanes with oxidative and hydrolytic enzymes. J Biomed Mater Res 1994; 28 (10) 1187-1199
    CrossrefPubMedGoogle Scholar
  • 51 Mezawa S, Homma H, Sato T , et al. A study of carboplatin-coated tube for the unresectable cholangiocarcinoma. Hepatology 2000; 32 (5) 916-923
    CrossrefPubMedGoogle Scholar
  • 52 Suk KT, Kim JW, Kim HS , et al. Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study. Gastrointest Endosc 2007; 66 (4) 798-803
    CrossrefPubMedGoogle Scholar
  • 53 Song TJ, Lee SS, Yun SC , et al. Paclitaxel-eluting covered metal stents versus covered metal stents for distal malignant biliary obstruction: a prospective comparative pilot study. Gastrointest Endosc 2011; 73 (4) 727-733
    CrossrefPubMedGoogle Scholar
  • 54 Okuda K, Nakanuma Y, Miyazaki M. Cholangiocarcinoma: recent progress. Part 1: epidemiology and etiology. J Gastroenterol Hepatol 2002; 17 (10) 1049-1055
    CrossrefPubMedGoogle Scholar
  • 55 Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 1975; 140 (2) 170-178
    PubMedGoogle Scholar
  • 56 Bismuth H, Castaing D, Traynor O. Resection or palliation: priority of surgery in the treatment of hilar cancer. World J Surg 1988; 12 (1) 39-47
    CrossrefPubMedGoogle Scholar
  • 57 Coons H. Metallic stents for the treatment of biliary obstruction: a report of 100 cases. Cardiovasc Intervent Radiol 1992; 15 (6) 367-374
    CrossrefPubMedGoogle Scholar
  • 58 Adam A. Metallic biliary endoprostheses. Cardiovasc Intervent Radiol 1994; 17 (3) 127-132
    PubMedGoogle Scholar
  • 59 Cowling MG, Adam AN. Internal stenting in malignant biliary obstruction. World J Surg 2001; 25 (3) 355-359 , discussion 359–361
    CrossrefPubMedGoogle Scholar
  • 60 Inal M, Akgül E, Aksungur E, Seydaoğlu G. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol 2003; 14 (11) 1409-1416
    CrossrefPubMedGoogle Scholar
  • 61 Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc 1998; 47 (5) 354-362
    CrossrefPubMedGoogle Scholar
  • 62 Naitoh I, Hayashi K, Nakazawa T , et al. Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci 2012; 57 (12) 3279-3285
    CrossrefPubMedGoogle Scholar
  • 63 Kim CW, Park AW, Won JW, Kim S, Lee JW, Lee SH. T-configured dual stent placement in malignant biliary hilar duct obstructions with a newly designed stent. J Vasc Interv Radiol 2004; 15 (7) 713-717
    CrossrefPubMedGoogle Scholar
  • 64 Gwon DI, Ko GY, Yoon HK , et al. Safety and efficacy of percutaneous Y-configured covered stent placement for malignant hilar biliary obstruction: a prospective, pilot study. J Vasc Interv Radiol 2012; 23 (4) 528-534
    CrossrefPubMedGoogle Scholar
  • 65 Yun JH, Jung GS, Park JG , et al. Malignant hilar biliary obstruction: Treatment by means of placement of a newly designed Y-shaped branched covered stent. Cardiovasc Intervent Radiol 2016; 39 (4) 582-590
    CrossrefPubMedGoogle Scholar
  • 66 Corvino F, Centore L, Soreca E, Corvino A, Farbo V, Bencivenga A. Percutaneous “Y” biliary stent placement in palliative treatment of type 4 malignant hilar stricture. J Gastrointest Oncol 2016; 7 (2) 255-261
    PubMedGoogle Scholar
  • 67 Bae JI, Park AW, Choi SJ , et al. Crisscross-configured dual stent placement for trisectoral drainage in patients with advanced biliary hilar malignancies. J Vasc Interv Radiol 2008; 19 (11) 1614-1619
    CrossrefPubMedGoogle Scholar
  • 68 Bruha R, Petrtyl J, Kubecova M , et al. Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies–the question of long-term palliation. Hepatogastroenterology 2001; 48 (39) 631-637
    PubMedGoogle Scholar
  • 69 Fritz P, Brambs HJ, Schraube P, Freund U, Berns C, Wannenmacher M. Combined external beam radiotherapy and intraluminal high dose rate brachytherapy on bile duct carcinomas. Int J Radiat Oncol Biol Phys 1994; 29 (4) 855-861
    CrossrefPubMedGoogle Scholar
  • 70 Aggarwal R, Patel FD, Kapoor R, Kang M, Kumar P, Chander Sharma S. Evaluation of high-dose-rate intraluminal brachytherapy by percutaneous transhepatic biliary drainage in the palliative management of malignant biliary obstruction–a pilot study. Brachytherapy 2013; 12 (2) 162-170
    CrossrefPubMedGoogle Scholar
  • 71 Kocak Z, Ozkan H, Adli M, Garipagaoglu M, Kurtman C, Cakmak A. Intraluminal brachytherapy with metallic stenting in the palliative treatment of malignant obstruction of the bile duct. Radiat Med 2005; 23 (3) 200-207
    PubMedGoogle Scholar
  • 72 Eschelman DJ, Shapiro MJ, Bonn J , et al. Malignant biliary duct obstruction: long-term experience with Gianturco stents and combined-modality radiation therapy. Radiology 1996; 200 (3) 717-724
    CrossrefPubMedGoogle Scholar
  • 73 Takamura A, Saito H, Kamada T , et al. Intraluminal low-dose-rate 192Ir brachytherapy combined with external beam radiotherapy and biliary stenting for unresectable extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys 2003; 57 (5) 1357-1365
    CrossrefPubMedGoogle Scholar
  • 74 Isayama H, Tsujino T, Nakai Y , et al. Clinical benefit of radiation therapy and metallic stenting for unresectable hilar cholangiocarcinoma. World J Gastroenterol 2012; 18 (19) 2364-2370
    CrossrefPubMedGoogle Scholar
  • 75 Shin HS, Seong J, Kim WC , et al. Combination of external beam irradiation and high-dose-rate intraluminal brachytherapy for inoperable carcinoma of the extrahepatic bile ducts. Int J Radiat Oncol Biol Phys 2003; 57 (1) 105-112
    CrossrefPubMedGoogle Scholar
  • 76 Cho YK, Kim JK, Kim MY, Rhim H, Han JK. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology 2009; 49 (2) 453-459
    CrossrefPubMedGoogle Scholar
  • 77 Mulier S, Ruers T, Jamart J, Michel L, Marchal G, Ni Y. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? An update. Dig Surg 2008; 25 (6) 445-460
    CrossrefPubMedGoogle Scholar
  • 78 Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ. Radiofrequency ablation of liver tumors: a systematic review. Arch Surg 2006; 141 (2) 181-190
    CrossrefPubMedGoogle Scholar
  • 79 Zacharoulis D, Lazoura O, Sioka E , et al. Habib EndoHPB: a novel endobiliary radiofrequency ablation device. An experimental study. J Invest Surg 2013; 26 (1) 6-10
    CrossrefPubMedGoogle Scholar
  • 80 Itoi T, Isayama H, Sofuni A , et al. Evaluation of effects of a novel endoscopically applied radiofrequency ablation biliary catheter using an ex-vivo pig liver. J Hepatobiliary Pancreat Sci 2012; 19 (5) 543-547
    CrossrefPubMedGoogle Scholar
  • 81 Steel AW, Postgate AJ, Khorsandi S , et al. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc 2011; 73 (1) 149-153
    CrossrefPubMedGoogle Scholar
  • 82 Mizandari M, Pai M, Xi F , et al. Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2013; 36 (3) 814-819
    CrossrefPubMedGoogle Scholar
  • 83 Li TF, Huang GH, Li Z , et al. Percutaneous transhepatic cholangiography and intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction. J Vasc Interv Radiol 2015; 26 (5) 715-721
    CrossrefPubMedGoogle Scholar
  • 84 Wang J, Zhao L, Zhou C , et al. Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for nonresectable malignant biliary obstruction improves stent patency but not survival. Medicine (Baltimore) 2016; 95 (15) e3329
    CrossrefPubMedGoogle Scholar
  • 85 Pai M, Valek V, Tomas A , et al. Percutaneous intraductal radiofrequency ablation for clearance of occluded metal stent in malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2014; 37 (1) 235-240
    CrossrefPubMedGoogle Scholar
  • 86 Duan XH, Wang YL, Han XW , et al. Intraductal radiofrequency ablation followed by locoregional tumor treatments for treating occluded biliary stents in non-resectable malignant biliary obstruction: A single-institution experience. PLoS One 2015; 10 (8) e0134857
    CrossrefPubMedGoogle Scholar
  • 87 McCaughan Jr JS, Mertens BF, Cho C, Barabash RD, Payton HW. Photodynamic therapy to treat tumors of the extrahepatic biliary ducts. A case report. Arch Surg 1991; 126 (1) 111-113
    CrossrefPubMedGoogle Scholar
  • 88 Abels C. Targeting of the vascular system of solid tumours by photodynamic therapy (PDT). Photochem Photobiol Sci 2004; 3 (8) 765-771
    CrossrefPubMedGoogle Scholar
  • 89 Castano AP, Mroz P, Hamblin MR. Photodynamic therapy and anti-tumour immunity. Nat Rev Cancer 2006; 6 (7) 535-545
    CrossrefPubMedGoogle Scholar
  • 90 Ortner MA. Photodynamic therapy for cholangiocarcinoma: overview and new developments. Curr Opin Gastroenterol 2009; 25 (5) 472-476
    CrossrefPubMedGoogle Scholar
  • 91 Leggett CL, Gorospe EC, Murad MH, Montori VM, Baron TH, Wang KK. Photodynamic therapy for unresectable cholangiocarcinoma: a comparative effectiveness systematic review and meta-analyses. Photodiagn Photodyn Ther 2012; 9 (3) 189-195
    CrossrefPubMedGoogle Scholar
  • 92 Lu Y, Liu L, Wu JC, Bie LK, Gong B. Efficacy and safety of photodynamic therapy for unresectable cholangiocarcinoma: A meta-analysis. Clin Res Hepatol Gastroenterol 2015; 39 (6) 718-724
    CrossrefPubMedGoogle Scholar