Endoscopic radiofrequency ablation to prolong survival for unresectable extrahepatic biliary cancer

Jong, David M. de; Cahen, Djuna L.

doi:10.1016/j.gie.2021.02.018

Cited by 1 publication

(2 citation statements)

References 8 publications

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“…A possible explanation for the onset of suppurative cholecystitis could be the obstruction of the cystic duct, as a consequence of its thermal injury due to edema or tissue destruction when ERFA is delivered too close to the opening in the bile duct ( 10 , 65 ). However, cholecysistis is not always reported after ERFA ( 18 ), and it has been hypothesized that the type (plastic vs metal) and the number (1-2 vs multiple) of biliary stents could be associated with a higher risk of cystic duct blockage ( 13 ). Since the reported total number of cases of cholecystis remains low and this complication resolves in few days with percutaneous gallbladder drainage and/or antibiotics, ERFA with subsequent biliary drainage is considered safe, even when the biliary stricture is close to the opening of the cystic duct ( 65 ).…”

Section: Endobiliary Radiofrequency Ablationmentioning

confidence: 99%

“…Recently, endobiliary radiofrequency ablation (ERFA) has been experimented as a treatment modality to reduce the tumor mass and delay tumor growth, extending stent patency (9)(10)(11)(12). Several studies have demonstrated that ERFA is associated with an increased median survival of approximately 6 months in patients with CCA, without increasing the risk of complications (13)(14)(15)(16)(17)(18)(19). However, the improved overall survival could be simply secondary to the effect of ERFA on stent patency, which is usually prolonged by approximately 2 months (20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

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Impact of endobiliary radiofrequency ablation on survival of patients with unresectable cholangiocarcinoma: a narrative review

et al. 2023

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Cholangiocarcinoma (CCA) is a rare cancer originating from the biliary epithelium and accounts for about 3% of all gastrointestinal malignancies. Unfortunately, the majority of patients are not eligible for surgical resection at the time of diagnosis, because of the locally advanced stage or metastatic disease. The overall survival time of unresectable CCA is generally less than 1 year, despite current chemotherapy regimens. Biliary drainage is often required as a palliative treatment for patients with unresectable CCA. Recurrent jaundice and cholangitis tend to occur because of reobstruction of the biliary stents. This not only jeopardizes the efficacy of chemotherapy, but also causes significant morbidity and mortality. Effective control of tumor growth is crucial for prolonging stent patency and consequently patient survival. Recently, endobiliary radiofrequency ablation (ERFA) has been experimented as a treatment modality to reduce tumor mass, and delay tumor growth, extending stent patency. Ablation is accomplished by means of high-frequency alternating current which is released from the active electrode of an endobiliary probe placed in a biliary stricture. It has been shown that tumor necrosis releases intracellular particles which are highly immunogenic and activate antigen-presenting cells, enhancing local immunity directed against the tumor. This immunogenic response could potentially enhance tumor suppression and be responsible for improved survival of patients with unresectable CCA who undergo ERFA. Several studies have demonstrated that ERFA is associated with an increased median survival of approximately 6 months in patients with unresectable CCA. Furthermore, recent data support the hypothesis that ERFA could ameliorate the efficacy of chemotherapy administered to patients with unresectable CCA, without increasing the risk of complications. This narrative review discusses the results of the studies published in recent years and focuses on the impact that ERFA could have on overall survival of patients with unresectable cholangiocarcinoma.

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