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Published in: Digestive Diseases and Sciences 7/2015

01-07-2015 | Original Article

Impact of Radiofrequency Ablation on Malignant Biliary Strictures: Results of a Collaborative Registry

Authors: Reem Z. Sharaiha, Amrita Sethi, Kristen R. Weaver, Tamas A. Gonda, Raj J. Shah, Norio Fukami, Prashant Kedia, Nikhil A. Kumta, Carlos M. Rondon Clavo, Michael D. Saunders, Jorge Cerecedo-Rodriguez, Paola Figueroa Barojas, Jessica L. Widmer, Monica Gaidhane, William R. Brugge, Michel Kahaleh

Published in: Digestive Diseases and Sciences | Issue 7/2015

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Abstract

Background

Radiofrequency ablation of malignant biliary strictures has been offered for the last 3 years, but only limited data have been published.

Aim

To assess the safety, efficacy, and survival outcomes of patients receiving endoscopic radiofrequency ablation.

Methods

Between April 2010 and December 2013, 69 patients with unresectable neoplastic lesions and malignant biliary obstruction underwent 98 radiofrequency ablation sessions with stenting.

Results

A total of 69 patients (22 male, aged 66.1 ± 13.3) were included in the registry. The etiology of malignant biliary stricture included unresectable cholangiocarcinoma (n = 45), pancreatic cancer (n = 19), gallbladder cancer (n = 2), gastric cancer (n = 1), and liver metastasis from colon cancer (n = 3). Seventy-eight percentage of patients had prior chemotherapy. All strictures were stented post-radiofrequency ablation with either plastic stents or metal stents. The mean stricture length treated was 14.3 mm. There was a statistically significant improvement in stricture diameter post-ablation (p < 0.0001). The likelihood of stricture improvement was significantly greater in pancreatic cancer-associated strictures [RR 1.8 (95 % 1.03–5.38)]. Seven patients (10 %) had adverse events, not linked directly to radiofrequency ablation. Median survival was 11.46 months (6.2–25 months).

Conclusion

Radiofrequency ablation is effective and safe in malignant biliary obstruction and seems to be associated with improved survival.
Literature
1.
go back to reference Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61:1657–1669.PubMedCrossRef Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61:1657–1669.PubMedCrossRef
6.
go back to reference Andersen JR, Sorensen SM, Kruse A, et al. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989;30:1132–1135.PubMedCentralPubMedCrossRef Andersen JR, Sorensen SM, Kruse A, et al. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989;30:1132–1135.PubMedCentralPubMedCrossRef
7.
go back to reference O’Brien S, Hatfield AR, Craig PI, et al. A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. Gut. 1995;36:618–621.PubMedCentralPubMedCrossRef O’Brien S, Hatfield AR, Craig PI, et al. A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. Gut. 1995;36:618–621.PubMedCentralPubMedCrossRef
8.
go back to reference Prat F, Chapat O, Ducot B, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc. 1998;47:1–7.PubMedCrossRef Prat F, Chapat O, Ducot B, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc. 1998;47:1–7.PubMedCrossRef
9.
go back to reference Shepherd HA, Royle G, Ross AP, et al. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg. 1988;75:1166–1168.PubMedCrossRef Shepherd HA, Royle G, Ross AP, et al. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg. 1988;75:1166–1168.PubMedCrossRef
10.
go back to reference 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;70:445–453.PubMedCrossRef 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;70:445–453.PubMedCrossRef
11.
go back to reference Lencioni R, Goletti O, Armillotta N, et al. Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial. Eur Radiol. 1998;8:1205–1211.PubMedCrossRef Lencioni R, Goletti O, Armillotta N, et al. Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial. Eur Radiol. 1998;8:1205–1211.PubMedCrossRef
12.
go back to reference Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am. 1995;1:73–81.PubMed Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am. 1995;1:73–81.PubMed
13.
go back to reference Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–468.PubMedCentralPubMedCrossRef Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–468.PubMedCentralPubMedCrossRef
14.
go back to reference Vavra P, Dostalik J, Zacharoulis D, et al. Endoscopic radiofrequency ablation in colorectal cancer: initial clinical results of a new bipolar radiofrequency ablation device. Dis Colon Rectum. 2009;52:355–358.PubMedCrossRef Vavra P, Dostalik J, Zacharoulis D, et al. Endoscopic radiofrequency ablation in colorectal cancer: initial clinical results of a new bipolar radiofrequency ablation device. Dis Colon Rectum. 2009;52:355–358.PubMedCrossRef
15.
go back to reference 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;2013:1–5.CrossRef 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;2013:1–5.CrossRef
16.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
18.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
19.
go back to reference Schmassmann A, von Gunten E, Knuchel J, et al. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996;91:654–659.PubMed Schmassmann A, von Gunten E, Knuchel J, et al. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996;91:654–659.PubMed
20.
go back to reference Moss AC, Morris E, Leyden J, et al. Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol. 2007;19:1119–1124.PubMedCrossRef Moss AC, Morris E, Leyden J, et al. Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol. 2007;19:1119–1124.PubMedCrossRef
21.
go back to reference Yoon WJ, Ryu JK, Yang KY, et al. A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc. 2009;70:284–289.PubMedCrossRef Yoon WJ, Ryu JK, Yang KY, et al. A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc. 2009;70:284–289.PubMedCrossRef
22.
go back to reference Yoon WJ, Lee JK, Lee KH, et al. A comparison of covered and uncovered wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc. 2006;63:996–1000.PubMedCrossRef Yoon WJ, Lee JK, Lee KH, et al. A comparison of covered and uncovered wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc. 2006;63:996–1000.PubMedCrossRef
23.
go back to reference Moses PL, Alnaamani KM, Barkun AN, et al. Randomized trial in malignant biliary obstruction: plastic vs partially covered metal stents. World J Gastroenterol. 2013;19:8638–8646.PubMedCentralPubMedCrossRef Moses PL, Alnaamani KM, Barkun AN, et al. Randomized trial in malignant biliary obstruction: plastic vs partially covered metal stents. World J Gastroenterol. 2013;19:8638–8646.PubMedCentralPubMedCrossRef
24.
go back to reference Wagner HJ, Knyrim K, Vakil N, et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy. 1993;25:213–218.PubMedCrossRef Wagner HJ, Knyrim K, Vakil N, et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy. 1993;25:213–218.PubMedCrossRef
25.
go back to reference Saleem A, Leggett CL, Murad MH, et al. 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;74:321–327 e1–e3. Saleem A, Leggett CL, Murad MH, et al. 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;74:321–327 e1–e3.
26.
go back to reference Hong WD, Chen XW, Wu WZ, et al. Metal versus plastic stents for malignant biliary obstruction: an update meta-analysis. Clin Res Hepatol Gastroenterol. 2013;37:496–500.PubMedCrossRef Hong WD, Chen XW, Wu WZ, et al. Metal versus plastic stents for malignant biliary obstruction: an update meta-analysis. Clin Res Hepatol Gastroenterol. 2013;37:496–500.PubMedCrossRef
27.
go back to reference Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of hepatic metastases. Surgery. 1988;103:278–288. Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of hepatic metastases. Surgery. 1988;103:278–288.
28.
go back to reference Farley DR, Weaver AL, Nagorney DM. “Natural history” of unresected cholangiocarcinoma: patient outcome after noncurative intervention. Mayo Clin Proc. 1995;70:425–429.PubMedCrossRef Farley DR, Weaver AL, Nagorney DM. “Natural history” of unresected cholangiocarcinoma: patient outcome after noncurative intervention. Mayo Clin Proc. 1995;70:425–429.PubMedCrossRef
29.
30.
go back to reference Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc. 1998;47:354–362.PubMedCrossRef Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc. 1998;47:354–362.PubMedCrossRef
31.
go back to reference Choi J, Ryu JK, Lee SH, et al. Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach. Hepatobiliary Pancreat Dis Int. 2012;11:636–642.PubMedCrossRef Choi J, Ryu JK, Lee SH, et al. Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach. Hepatobiliary Pancreat Dis Int. 2012;11:636–642.PubMedCrossRef
32.
go back to reference Mihalache F, Tantau M, Diaconu B, et al. Survival and quality of life of cholangiocarcinoma patients: a prospective study over a 4 year period. J Gastrointest Liver Dis. 2010;19:285–290. Mihalache F, Tantau M, Diaconu B, et al. Survival and quality of life of cholangiocarcinoma patients: a prospective study over a 4 year period. J Gastrointest Liver Dis. 2010;19:285–290.
33.
go back to reference Alexopoulou A, Soultati A, Dourakis SP, et al. Cholangiocarcinoma: a 7-year experience at a single center in Greece. World J Gastroenterol. 2008;14:6213–6217.PubMedCentralPubMedCrossRef Alexopoulou A, Soultati A, Dourakis SP, et al. Cholangiocarcinoma: a 7-year experience at a single center in Greece. World J Gastroenterol. 2008;14:6213–6217.PubMedCentralPubMedCrossRef
35.
go back to reference Pereira SP, Ayaru L, Rogowska A, et al. Photodynamic therapy of malignant biliary strictures using meso-tetrahydroxyphenylchlorin. Eur J Gastroenterol Hepatol. 2007;19:479–485.PubMedCrossRef Pereira SP, Ayaru L, Rogowska A, et al. Photodynamic therapy of malignant biliary strictures using meso-tetrahydroxyphenylchlorin. Eur J Gastroenterol Hepatol. 2007;19:479–485.PubMedCrossRef
36.
go back to reference Zoepf T, Jakobs R, Arnold JC, et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol. 2005;100:2426–2430.PubMedCrossRef Zoepf T, Jakobs R, Arnold JC, et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol. 2005;100:2426–2430.PubMedCrossRef
37.
go back to reference Chahal P, Baron TH. Endoscopic palliation of cholangiocarcinoma. Curr Opin Gastroenterol. 2006;22:551–560.PubMedCrossRef Chahal P, Baron TH. Endoscopic palliation of cholangiocarcinoma. Curr Opin Gastroenterol. 2006;22:551–560.PubMedCrossRef
38.
go back to reference Bruha R, Petrtyl J, Kubecova M, et al. Intraluminal brachytherapy and self expandable stents in nonresectable biliary malignancies: the question of long-term palliation. Hepatogastroenterology. 2001;48:631–637.PubMed Bruha R, Petrtyl J, Kubecova M, et al. Intraluminal brachytherapy and self expandable stents in nonresectable biliary malignancies: the question of long-term palliation. Hepatogastroenterology. 2001;48:631–637.PubMed
39.
go back to reference Montemaggi P, Costamagna G, Dobelbower RR, et al. Intraluminal brachytherapy in the treatment of pancreas and bile duct carcinoma. Int J Radiat Oncol Biol Phys. 1995;32:437–443.PubMedCrossRef Montemaggi P, Costamagna G, Dobelbower RR, et al. Intraluminal brachytherapy in the treatment of pancreas and bile duct carcinoma. Int J Radiat Oncol Biol Phys. 1995;32:437–443.PubMedCrossRef
40.
go back to reference Ishii H, Furuse J, Nagase M, et al. Relief of jaundice by external beam radiotherapy and intraluminal brachytherapy in patients with extrahepatic cholangiocarcinoma: results without stenting. Hepatogastroenterology. 2004;51:954–957.PubMed Ishii H, Furuse J, Nagase M, et al. Relief of jaundice by external beam radiotherapy and intraluminal brachytherapy in patients with extrahepatic cholangiocarcinoma: results without stenting. Hepatogastroenterology. 2004;51:954–957.PubMed
41.
go back to reference Kuvshinoff BW, Armstrong JG, Fong Y, et al. Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy. Br J Surg. 1995;82:1522–1525.PubMedCrossRef Kuvshinoff BW, Armstrong JG, Fong Y, et al. Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy. Br J Surg. 1995;82:1522–1525.PubMedCrossRef
42.
go back to reference Vallis KA, Benjamin IS, Munro AJ, et al. External beam and intraluminal radiotherapy for locally advanced bile duct cancer: role and tolerability. Radiother Oncol. 1996;41:61–66.PubMedCrossRef Vallis KA, Benjamin IS, Munro AJ, et al. External beam and intraluminal radiotherapy for locally advanced bile duct cancer: role and tolerability. Radiother Oncol. 1996;41:61–66.PubMedCrossRef
43.
go back to reference Foo ML, Gunderson LL, Bender CE, et al. External radiation therapy and transcatheter iridium in the treatment of extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys. 1997;39:929–935.PubMedCrossRef Foo ML, Gunderson LL, Bender CE, et al. External radiation therapy and transcatheter iridium in the treatment of extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys. 1997;39:929–935.PubMedCrossRef
44.
go back to reference Gerhards MF, van Gulik TM, Gonzalez Gonzalez D, et al. Results of postoperative radiotherapy for resectable hilar cholangiocarcinoma. World J Surg. 2003;27:173–179.PubMed Gerhards MF, van Gulik TM, Gonzalez Gonzalez D, et al. Results of postoperative radiotherapy for resectable hilar cholangiocarcinoma. World J Surg. 2003;27:173–179.PubMed
Metadata
Title
Impact of Radiofrequency Ablation on Malignant Biliary Strictures: Results of a Collaborative Registry
Authors
Reem Z. Sharaiha
Amrita Sethi
Kristen R. Weaver
Tamas A. Gonda
Raj J. Shah
Norio Fukami
Prashant Kedia
Nikhil A. Kumta
Carlos M. Rondon Clavo
Michael D. Saunders
Jorge Cerecedo-Rodriguez
Paola Figueroa Barojas
Jessica L. Widmer
Monica Gaidhane
William R. Brugge
Michel Kahaleh
Publication date
01-07-2015
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 7/2015
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-015-3558-3

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