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Surgical Endoscopy
Published in: Surgical Endoscopy 8/2022

16-03-2022 | Cholangitis | Review Article

Local palliative therapies for unresectable malignant biliary obstruction: radiofrequency ablation combined with stent or biliary stent alone? An updated meta-analysis of nineteen trials

Authors: Shaoming Song, Haojie Jin, Qinghao Cheng, Shiyi Gong, Kun Lv, Ting Lei, Hongwei Tian, Xiaofei Li, Caining Lei, Wenwen Yang, Kehu Yang, Tiankang Guo

Published in: Surgical Endoscopy | Issue 8/2022

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Abstract

Background

Recently, there has been a burgeoning interest in radiofrequency ablation combined with stent (RFA + Stent) for unresectable malignant biliary obstruction (MBO). This study aimed to perform a meta-analysis to evaluate the efficacy and safety of RFA + Stent compared with biliary stent alone.

Methods

We searched PubMed, Cochrane Library, Embase, and Web of Science databases from their inception dates to June 20, 2021, for studies that compared RFA + Stent and stent alone for unresectable MBO. The main outcomes were survival, patency, and adverse effects. All meta-analyses were calculated using the random-effects model.

Results

A total of 19 studies involving 1946 patients were included in this study. Compared with stent alone, RFA + Stent was significantly associated with better overall survival (HR 0.55; 95% CI 0.48, 0.63; P < 0.00001), longer mean survival time (SMD 2.20; 95% CI 1.17, 3.22; P < 0.0001), longer mean stent patency time (SMD 1.37; 95% CI 0.47, 2.26; P = 0.003), higher stent patency at 6 months (OR 2.82; 95% CI 1.54, 5.18; P = 0.0008). The two interventions had similar incidence of postoperative abdominal pain (OR 1.29; 95% CI 0.94, 1.78; P = 0.11), mild bleeding (OR 1.28; 95% CI 0.65, 2.54; P = 0.48), cholangitis (OR 1.09; 95% CI 0.76, 1.55; P = 0.65), pancreatitis (OR 1.39; 95% CI 0.82, 2.38; P = 0.22). Furthermore, the serum bilirubin levels and stricture diameter after operations were significantly alleviated than before operations, but the degree of alleviation between the two groups were not significantly different (all P > 0.05).

Conclusion

Although the alleviation of serum bilirubin and stricture diameter did not differ between the two interventions, RFA + Stent can significantly improve the survival and stent patency with comparable procedure-related adverse events than stent alone. Thus, RFA + Stent should be recommended as an attractive alternative to biliary stent alone for patients with unresectable MBO.
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Literature
1.
Banales JM, Marin JJG, Lamarca A et al (2020) Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol 17(9):557–588PubMedPubMedCentralCrossRef
2.
Gupta N, Yelamanchi R (2021) Pancreatic adenocarcinoma: a review of recent paradigms and advances in epidemiology, clinical diagnosis and management. World J Gastroenterol 27(23):3158–3181PubMedPubMedCentralCrossRef
3.
Rizvi S, Khan SA, Hallemeier CL et al (2018) Cholangiocarcinoma—evolving concepts and therapeutic strategies. Nat Rev Clin Oncol 15(2):95–111PubMedCrossRef
4.
Abraham NS, Barkun JS, Barkun AN (2002) Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc 56(6):835–841PubMedCrossRef
5.
Khoo S, Do NDT, Kongkam P (2020) Efficacy and safety of EUS biliary drainage in malignant distal and hilar biliary obstruction: a comprehensive review of literature and algorithm. Endosc Ultrasound 9(6):369–379PubMedPubMedCentralCrossRef
6.
Monkemuller K, Popa D, Wilcox CM (2014) Endoscopic treatment options for cholangiocarcinomas. Expert Rev Anticancer Ther 14(4):407–418PubMedCrossRef
7.
Hamada T, Nakai Y, Isayama H et al (2021) Antireflux metal stent for biliary obstruction: any benefits? Dig Endosc 33(3):310–320PubMedCrossRef
8.
Zhu HD, Guo JH, Huang M et al (2018) Irradiation stents vs. conventional metal stents for unresectable malignant biliary obstruction: a multicenter trial. J Hepatol 68(5):970–977PubMedCrossRef
9.
10.
11.
Yang J, Wang J, Zhou H et al (2018) Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial. Endoscopy 50(8):751–760PubMedCrossRef
12.
Kang H, Chung MJ, Cho IR et al (2021) Efficacy and safety of palliative endobiliary radiofrequency ablation using a novel temperature-controlled catheter for malignant biliary stricture: a single-center prospective randomized phase II TRIAL. Surg Endosc 35(1):63–73PubMedCrossRef
13.
Cho JH, Jeong S, Kim EJ et al (2018) Long-term results of temperature-controlled endobiliary radiofrequency ablation in a normal swine model. Gastrointest Endosc 87(4):1147–1150PubMedCrossRef
14.
Habert P, Di Bisceglie M, Bartoli A et al (2021) Description of morphological evolution of lung tumors treated by percutaneous radiofrequency ablation: long term follow-up of 100 lesions with chest CT. Int J Hyperth 38(1):786–794CrossRef
15.
Yang Y, Yu H, Tan X et al (2021) Liver resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperth 38(1):875–886CrossRef
16.
Laquiere A, Boustiere C, Leblanc S et al (2016) Safety and feasibility of endoscopic biliary radiofrequency ablation treatment of extrahepatic cholangiocarcinoma. Surg Endosc Other Interv Tech 30(3):1242–1248CrossRef
17.
Yang KH, Li XX, Bai Z (2018) Research methods of evidence-based social science: systematic review and meta-analysis. Lanzhou University Press, Lanzhou
18.
Sofi AA, Khan MA, Das A et al (2018) Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 87(4):944-951.e1PubMedCrossRef
19.
20.
Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647PubMedCrossRef
21.
22.
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605PubMedCrossRef
23.
Wang Q, Wang J, Pan B et al (2020) Advance in the GRADE approach to rate the quality of evidence from a network meta-analysis. Chin J Evid Based Med 20(7):1–7
24.
Liu Q, Ding L (2019) Accessibility and validation of survival data in survival curve for meta-analysis. Chin J Evid Based Med 19(9):1124–1130
25.
Luo D, Wan X, Liu J et al (2018) Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 27(6):1785–1805PubMedCrossRef
26.
27.
Uyanık SA, Öğüşlü U, Çevik H et al (2021) Percutaneous endobiliary ablation of malignant biliary strictures with a novel temperature-controlled radiofrequency ablation device. Diagn Interv Radiol 27(1):102–108PubMedCrossRef
28.
Sharaiha RZ, Natov N, Glockenberg KS et al (2014) Comparison of metal stenting with radiofrequency ablation versus stenting alone for treating malignant biliary strictures: is there an added benefit? Dig Dis Sci 59(12):3099–3102PubMedCrossRef
29.
Kallis Y, Phillips N, Steel A et al (2015) Analysis of endoscopic radiofrequency ablation of biliary malignant strictures in pancreatic cancer suggests potential survival benefit. Dig Dis Sci 60(11):3449–3455PubMedCrossRef
30.
Li TF, Huang GH, Li Z et al (2015) Percutaneous transhepatic cholangiography and intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction. J Vasc Interv Radiol 26(5):715–721PubMedCrossRef
31.
Liang H, Peng Z, Cao L et al (2015) Metal stenting with or without endobiliary radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma. J Cancer Ther 06(11):981–992CrossRef
32.
Kadayifci A, Atar M, Forcione DG et al (2016) Radiofrequency ablation for the management of occluded biliary metal stents. Endoscopy 48(12):1096–1101PubMedCrossRef
33.
Liu J, Di K, Xu S et al (2016) Radiofrequency ablation combined with stent implantation in treatment of malignant biliary obstruction. Chin J Interv Imaging Ther 13(10):587–591
34.
Wang J, Zhao L, Zhou C et al (2016) Percutaneous Intraductal radiofrequency ablation combined with biliary stent placement for nonresectable malignant biliary obstruction improves stent patency but not survival. Medicine (Baltimore) 95(15):e3329CrossRef
35.
Cui W, Wang Y, Fan WZ et al (2017) Comparison of intraluminal radiofrequency ablation and stents vs. stents alone in the management of malignant biliary obstruction. Int J Hyperth 33(7):853–861
36.
Dutta AK, Basavaraju U, Sales L et al (2017) Radiofrequency ablation for management of malignant biliary obstruction: a single-center experience and review of the literature. Expert Rev Gastroenterol Hepatol 11(8):779–784PubMedCrossRef
37.
Wu TT, Li WM, Li HC et al (2017) Percutaneous intraductal radiofrequency ablation for extrahepatic distal cholangiocarcinoma: a method for prolonging stent patency and achieving better functional status and quality of life. Cardiovasc Intervent Radiol 40(2):260–269PubMedCrossRef
38.
Bokemeyer A, Matern P, Bettenworth D et al (2019) Endoscopic radiofrequency ablation prolongs survival of patients with unresectable hilar cholangiocellular carcinoma—a case-control study. Sci Rep 9(1):13685PubMedPubMedCentralCrossRef
39.
40.
Yu TZ, Zhang W, Li CY et al (2020) Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for treatment of malignant biliary obstruction. Abdom Radiol 45(11):3690–3697CrossRef
41.
42.
43.
Zheng X, Bo ZY, Wan W et al (2016) Endoscopic radiofrequency ablation may be preferable in the management of malignant biliary obstruction: a systematic review and meta-analysis. J Dig Dis 17(11):716–724PubMedCrossRef
44.
45.
Yang Q, Liu J, Ma W et al (2019) Efficacy of different endoscopic stents in the management of postoperative biliary strictures: a systematic review and meta-analysis. J Clin Gastroenterol 53(6):418–426PubMedCrossRef
46.
Tal AO, Vermehren J, Friedrich-Rust M et al (2014) Intraductal endoscopic radiofrequency ablation for the treatment of hilar non-resectable malignant bile duct obstruction. World J Gastrointest Endosc 6(1):13–19PubMedPubMedCentralCrossRef
Metadata
Title
Local palliative therapies for unresectable malignant biliary obstruction: radiofrequency ablation combined with stent or biliary stent alone? An updated meta-analysis of nineteen trials
Authors
Shaoming Song
Haojie Jin
Qinghao Cheng
Shiyi Gong
Kun Lv
Ting Lei
Hongwei Tian
Xiaofei Li
Caining Lei
Wenwen Yang
Kehu Yang
Tiankang Guo
Publication date
16-03-2022
Publisher
Springer US
Keyword
Cholangitis
Published in
Surgical Endoscopy / Issue 8/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-022-09181-2

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