387 Safety and Efficacy of Radiofrequency Ablation in the Management of Unresectable Bile Duct and Pancreatic Cancer: A Novel Palliation Technique

Abstract

Objectives. Radiofrequency ablation (RFA) has replaced photodynamic therapy for premalignant and malignant lesions of the esophagus. However, there is limited experience in the bile duct. The objective of this pilot study was to assess the safety and efficacy of RFA in malignant biliary strictures. Methods: Twenty patients with unresectable malignant biliary strictures underwent RFA with stenting between June 2010 and July 2012. Diameters of the stricture before and after RFA, immediate and 30 day complications and stent patency were recorded prospectively. Results. A total of 25 strictures were treated. Mean stricture length treated was 15.2 mm (SD = 8.7 mm, Range = 3.5-33 mm). Mean stricture diameter before RFA was 1.7 mm (SD = 0.9 mm, Range = 0.5-3.4 mm) while the mean diameter after RFA was 5.2 mm (SD = 2 mm, Range = 2.6-9 mm). There was a significant increase of 3.5 mm (t = 10.8, DF = 24, P value = <.0001) in the bile duct diameter post RFA. Five patients presented with pain after the procedure, but only one developed mild post-ERCP pancreatitis and cholecystitis. Conclusions: Radiofrequency ablation can be a safe palliation option for unresectable malignant biliary strictures. A multicenter randomized controlled trial is required to confirm the long term benefits of RFA and stenting compared to stenting alone.

Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA) of the Pancreas in a Porcine Model

“…Ablating with endoscopic ultrasound (EUS) guidance allows real-time imaging into the deeply located pancreas [ 4 ]. Radiofrequency ablation (RFA) works by emitting energy that uses heat to produce coagulative necrosis in the surrounding tissue [ 7 , 8 ]. There is a growing interest and need of RFA of the pancreas [ 4 ] and it appears that RFA in unresectable pancreatic carcinoma is feasible with acceptable mortality but high morbidity [ 5 , 6 , 8 – 11 ].…”

A Review of Direct Endobiliary Techniques for the Management of Biliary Conditions

“…New advances in percutaneous endoscopic technology and treatment techniques have been shown to be effective for symptom palliation and improved quality of life via biliary decompression. 5 6 7 They can also be used to improve stent patency and local tumor control. 7 8 9 10 11 Endoscopic retrograde cholangiopancreatography (ERCP), or percutaneous direct endobiliary therapy with radiofrequency ablation (RFA), microwave ablation (MWA), photodynamic therapy, high-intensity frequency ultrasound ablation, and intraluminal brachytherapy (ILBT) have been used for the management of these biliary conditions.…”