Endoscopy 2019; 51(04): S36
DOI: 10.1055/s-0039-1681276
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ERCP stenosis Club H
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC RADIOFREQUENCY ABLATION PROLONGS SURVIVAL IN PATIENTS WITH ADVANCED HILAR CHOLANGIOCELLULAR CARCINOMAS

A Bokemeyer
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
,
P Matern
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
,
D Bettenworth
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
,
F Cordes
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
,
T Nowacki
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
2   Joseph Hospital Warendorf, Department of Internal Medicine I, Warendorf, Germany
,
H Heinzow
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
,
I Kabar
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
,
H Schmidt
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
,
H Ullerich
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
,
F Lenze
1   University Hospital Münster, Department of Medicine B for Gastroenterology and Hepatology, Münster, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Patients with an unresectable advanced hilar cholangiocellular carcinoma (CCC) suffer from a particularly short life expectancy. Endoscopic radiofrequency ablation (ERFA) of the malignant biliary obstruction may substantially prolong survival in these patients.

Methods:

All CCC cases with an ERFA of the biliary tract, performed at our tertiary referral center between a six-year period from 2012 to 2017, were retrospectively analyzed. For survival analysis using Kaplan-Meier method, these cases were compared to historical control cases who received the endoscopic standard treatment of sole stent application. Historical controls were chosen from an equal time-period (from 2006 and 2011) in which ERFA was not yet available at our tertiary referral center.

Results:

ERFA was performed in 32 patients with malignant biliary strictures that were mainly caused by Bismuth III and IV hilar CCCs (66%). 44% of these patients had multiple ERFAs accounting for an overall performance of 54 ERFAs. ERFA procedures were successfully completed in all cases, for a technical success rate of 100%. In all patients, endoscopic stents were applied (100%). Complications occurred in 18.5% of cases of which a post-interventional cholangitis was most frequently observed (11.1%) followed by cases with a post-interventional pancreatitis (3.7%). No mortalities occurred due to procedure-related side effects.

The case-control analysis revealed that the survival time of cases with unresectable Bismuth type III and IV hilar CCCs (n = 20) treated with stent placement in combination with ERFA significantly prolonged survival in comparison to controls (n = 22) treated with sole endoscopic stent placement (342 vs. 221 days; p = 0.046).

Conclusions:

ERFA significantly prolongs survival in patients with an unresectable Bismuth type III and IV hilar CCC. Therefore, it provides an easy-to-use, effective and safe palliative treatment option for these patients.