Radiofrequency ablation for the management of occluded biliary metal stents
submitted 09 November 2015
accepted after revision 04 July 2016
07 October 2016 (online)
Background and study aim: Obstruction of biliary self-expandable metal stents (SEMSs) is seen frequently. Radiofrequency ablation (RFA) causes tissue necrosis. This study aimed to assess the efficacy of RFA for management of occluded SEMS.
Patients and methods: Patients with biliary malignancy and treated for an occluded SEMS were retrospectively reviewed. The study group comprised patients treated with RFA using an Habib endoprobe inside the SEMS. The control group comprised patients treated only with insertion of a plastic stent into an occluded SEMS. The end points were; 90-day stent patency rate, time to stent reocclusion, 30-day mortality, and 3 – and 6-month survival rates.
Results: During the 5-year study period 25 patients with an occluded SEMS underwent RFA and 25 patients underwent a plastic stent placement only. Both groups were matched for age and diagnosis. Immediate biliary drainage was restored in all patients. In the RFA group, the stenosis was ablated successfully in 14 patients (56 %); ablation failed in 11 and a plastic stent was then inserted into the SEMS for these. The control group had only placement of a plastic stent across the stenosis. Stent patency rate at 90 days was 56 % and 24 % in the RFA and control groups, respectively (P = 0.04). The mean stent patency time was significantly longer in the RFA group compared to the control group (119.5 vs. 65.3 days, P = 0.03).
Conclusion: The application of RFA for occluded SEMS improves stent patency. RFA is an alternative treatment of tissue ingrowth in malignant biliary obstruction.
- 1 Almadi MA, Barkun JS, Barkun AN. Stenting in malignant biliary obstruction. Gastrointest Endosc Clin N Am 2015; 25: 691-711
- 2 Sawas T, Al Halabi S, Parsi MA et al. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 2015; 82: 256-267.e257
- 3 Dumonceau JM, Tringali A, Blero D et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2012; 44: 277-298
- 4 Kim YS, Lim HK, Rhim H et al. Ablation of hepatocellular carcinoma. Best Pract Res Clin Gastroenterol 2014; 28: 897-908
- 5 Stoltz A, Gagniere J, Dupre A et al. Radiofrequency ablation for colorectal liver metastases. J Visc Surg 2014; 151 (Suppl. 01) 33-S44
- 6 Davila ML, Hofstetter WL. Endoscopic management of Barrett’s esophagus with high-grade dysplasia and early-stage esophageal adenocarcinoma. Thorac Surg Clin 2013; 23: 479-489
- 7 Baba Y, Watanabe M, Yoshida N et al. Radiofrequency ablation for pulmonary metastases from gastrointestinal cancers. Ann Thorac Cardiovasc Surg 2014; 20: 99-105
- 8 Song TJ, Seo DW, Lakhtakia S et al. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc 2016; 83: 440-443
- 9 Zacharoulis D, Lazoura O, Sioka E et al. Habib EndoHPB: a novel endobiliary radiofrequency ablation device. An experimental study. J Invest Surg 2013; 26: 6-10
- 10 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: 149-153
- 11 Alis H, Sengoz C, Gonenc M et al. Endobiliary radiofrequency ablation for malignant biliary obstruction. Hepatobiliary Pancreat Dis Int 2013; 12: 423-427
- 12 Figueroa-Barojas P, Bakhru MR, Habib NA et al. Safety and efficacy of radiofrequency ablation in the management of unresectable bile duct and pancreatic cancer: a novel palliation technique. J Oncol 2013; DOI: 10.1155/2013/910897.
- 13 Daglilar ES, Yoon WJ, Mino-Kenudson M et al. Controlled swine bile duct ablation with a bipolar radiofrequency catheter. Gastrointest Endosc 2013; 77: 815-819
- 14 Daglilar ES, Atar M, Hagen C et al. Sa1616 Ex-vivo human bile duct ablation with a bipolar radiofrequency catheter. Gastrointest Endosc 2014; 79: AB275
- 15 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: 3099-3102
- 16 Dolak W, Schreiber F, Schwaighofer H et al. Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications. Surg Endosc 2014; 28: 854-860
- 17 Sharaiha RZ, Sethi A, Weaver KR et al. Impact of radiofrequency ablation on malignant biliary strictures: results of a collaborative registry. Dig Dis Sci 2015; 60: 2164-2169
- 18 Rustagi T, Jamidar PA. Intraductal radiofrequency ablation for management of malignant biliary obstruction. Dig Dis Sci 2014; 59: 2635-2641
- 19 Pozsár J, Tarpay Á, Burai J et al. Intraductal radiofrequency ablation can restore patency of occluded biliary self-expanding metal stents. Z Gastroenterol 2011; 49: A70
- 20 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: 235-240
- 21 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: e0134857