Efficacy and safety of radiofrequency ablation in patients with unresectable malignant biliary strictures

Orozco, Martha C. Galindo; Guerrero, Angélica Hernández; Lárraga, Juan Octavio Alonso; Solis, E.; Levy, José Guillermo de la Mora; Robleda, María Del Carmen Manzano

doi:10.17235/reed.2020.7023/2020

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Numerous studies have explored the role of ERCP‐guided RFA in improving the survival of MBS patients, including five RCTs (Table 1). 9,11,12,17,21,25–30,44–47 However, the results are controversial. Some RCTs have not shown any survival benefits from RFA.…”

Section: Indications For Endobiliary Rfamentioning

confidence: 99%

“…Pathological examination found that the maximum ablation depth was 4.0 mm (range 1.0–6.0 mm), the median effective ablation length was 72.0% (range 42.1%–95.3%), and there were no pathological manifestations such as bile duct perforation, bleeding, cholecystitis, and cholangitis 55 . Most previous clinical studies use an ablation power of 7–10 W for 90–120 s 26–30,44–47 or a target temperature of 80 °C, 55,59 which is safe and effective.…”

Section: Operation Of Endobiliary Rfamentioning

confidence: 99%

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Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures

2024

J of Digest Diseases

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Endoscopic guided endobiliary radiofrequency ablation has recently been an emerging treatment for malignant biliary strictures. It can effectively delay the local progression of tumors, improve the quality of life, and prolong the survival of patients, combined with biliary stenting and systemic chemotherapy, etc, which is mainly suitable for inoperable patients with extrahepatic cholangiocarcinoma and ampullary cancer. Based on the existing clinical evidence, the Chinese Society of Digestive Endoscopy, the Digestive Endoscopy Professional Committee of the Chinese Medical Doctor Association, and the National Clinical Research Center for Digestive Diseases (Shanghai) organized relevant experts to discuss the indications, contraindications, technical operation specifications and complications prevention and treatment of endoscopically guided endobiliary radiofrequency ablation. They reached consensus statements to provide references for the clinical standardized treatment of biliary malignant tumors.This article is protected by copyright. All rights reserved.

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Section: Indications For Endobiliary Rfamentioning

confidence: 99%

Section: Operation Of Endobiliary Rfamentioning

confidence: 99%

Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures

2024

J of Digest Diseases

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“…Importantly, one of these studies excluded patients with Bismuth IV tumors (213) and the other excluded patients with Bismuth III and IV tumors (222). Comparative retrospective cohort studies have also included heterogeneous patient populations but have demonstrated consistently favorable outcomes associated with RFA (223)(224)(225)(226). Three metaanalyses have affirmed a survival benefit associated with endobiliary RFA compared with a strategy of stent exchange alone (227)(228)(229).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures

et al. 2023

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A biliary stricture is an abnormal narrowing in the ductal drainage system of the liver that can result in clinically and physiologically relevant obstruction to the flow of bile. The most common and ominous etiology is malignancy, underscoring the importance of a high index of suspicion in the evaluation of this condition. The goals of care in patients with a biliary stricture are confirming or excluding malignancy (diagnosis) and reestablishing flow of bile to the duodenum (drainage); the approach to diagnosis and drainage varies according to anatomic location (extrahepatic vs perihilar). For extrahepatic strictures, endoscopic ultrasound-guided tissue acquisition is highly accurate and has become the diagnostic mainstay. In contrast, the diagnosis of perihilar strictures remains a challenge. Similarly, the drainage of extrahepatic strictures tends to be more straightforward and safer and less controversial than that of perihilar strictures. Recent evidence has provided some clarity in multiple important areas pertaining to biliary strictures, whereas several remaining controversies require additional research. The goal of this guideline is to provide practicing clinicians with the most evidence-based guidance on the approach to patients with extrahepatic and perihilar strictures, focusing on diagnosis and drainage.

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“…The same researcher also compared their clinical findings with the results of the National Cancer Cooperative Registration Database (SEER), 22 and found that RFA improved the median survival of patients with CCA (17.7 months vs. 6.2 months, P < 0.0001). So far, there have been a large number of studies on endoscopic biliary RFA (Table 1), 21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] including five randomized controlled trials (RCTs). Interestingly, there was no complete agreement among these studies on the survival benefits of endoscopic RFA for unresectable MBS.…”

Section: Introductionmentioning

confidence: 99%

Endobiliary radiofrequency ablation for unresectable malignant biliary strictures: Survival benefit perspective

Xia

Qin

2023

Digestive Endoscopy

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Endobiliary radiofrequency ablation (RFA) is an emerging technique in recent years for palliating malignant biliary strictures (MBS) unsuitable for surgical resection. To date, many clinical studies have shown good feasibility and safety of this therapy; but controversy exists on whether survival can be improved in patients with advanced MBS. A comprehensive review of the available literature demonstrates that RFA can effectively prolong the overall survival of extrahepatic cholangiocarcinoma (CCA) and ampullary cancer, especially in cases without distant metastasis. However, this topical therapy does not confer a survival benefit in patients with nonprimary bile duct malignancies, such as liver, gallbladder, or pancreatic cancers. Biliary RFA combined with systemic chemotherapy may have a synergistic effect on the outcome of inoperable CCA. Patients with locally advanced tumors rather than distant metastasis might benefit more from this combination therapy.

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Efficacy and safety of radiofrequency ablation in patients with unresectable malignant biliary strictures

Cited by 4 publications

References 13 publications

Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures

Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures

ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures

Endobiliary radiofrequency ablation for unresectable malignant biliary strictures: Survival benefit perspective

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