A review of the recent advances in endoscopic retrograde cholangiography-guided intraductal radiofrequency ablation for malignant biliary strictures

Abstract

Pancreatobiliary malignancy is relatively rare; however, it remains one of the most lethal malignancies and has a dismal prognosis. Endoscopic retrograde cholangiopancreatography (ERCP)-guided intraductal radiofrequency ablation (ID-RFA) is a promising, minimally invasive treatment for unresectable malignant biliary strictures by delivering high-frequency alternating current to the target tissue, leading to coagulative necrosis. Recent studies have provided evidence that ERCP-guided ID-RFA is a safe, well-tolerated, and effective adjunctive treatment in terms of stent patency as well as overall survival. Compared with other local treatments, such as photodynamic therapy, ERCP-guided ID-RFA has advantages, including ease of delivery, controlled application of thermal energy, low cost, and fewer systemic side effects, with an acceptable safety profile. ERCP-guided ID-RFA has been proposed as an attractive endobiliary ablative therapy and is regarded to be an adjuvant method for the palliative care of patients with unresectable malignant biliary strictures. However, due to the ongoing lack of comparative studies, the choice of local ablative therapy remains, in each case, an individual decision by the multidisciplinary team.

Endobiliary Radiofrequency Ablation for Malignant Biliary Obstruction over 32-Month Follow-Up

“…If the initial PS becomes occluded, replacement with an uncovered self-expandable metal stent (ucSEMS) is favored if the estimated survival is expected to be greater than 6 months [2]. However, tumor ingrowth through the stent represents one of the most frequent complications causing cholestatic disease and cholangitis [1][2][3]. In this case, different approaches are reported in the literature: percutaneous biliary drainage, endosonography-guided biliary drainage, surgical bypass, local ablative therapy: photodynamic therapy (PDT), intraductal (ID) RFA (ID-RFA), and intraluminal brachytherapy [1].…”