Endoscopic radiofrequency biliary ablation treatment: A comprehensive review

Abstract

Radiofrequency ablation (RFA) functions by delivering thermal energy within tissue, the result of a high‐frequency alternating current released from an active electrode, leading to coagulative necrosis and cellular death. Recently, a biliary catheter working on a guidewire has been developed and a number of studies have so far been carried out. The present article provides a comprehensive review of the literature on the results of the use of RFA for the clinical management of patients with unresectable malignant biliary strictures, benign biliary strictures, and residual adenomatous tissue in the bile duct after endoscopic papillectomy. Available data show that biliary RFA treatment is a promising adjuvant therapy in patients with unresectable malignant biliary obstruction. The procedure is safe, well tolerated and improves stent patency and survival, even though more studies are warranted. In patients with residual endobiliary adenomatous tissue after endoscopic papillectomy, a significant rate of neoplasia eradication after a single RFA session has been reported, thus favoring this treatment over surgical intervention. In these patients, as well as in those with benign biliary strictures, dedicated probes with a short electrode able to focus the RF current on the short stenosis are needed to expand RFA treatment for these indications.

Novel balloon catheter‐based endobiliary radiofrequency ablation system: Ex‐vivo experimental study

“…E NDOBILIARY RADIOFREQUENCY ABLATION (RFA) is an emerging modality for the local treatment of malignant biliary strictures and is considered a new endoscopic palliative adjunctive procedure, which has been increasingly performed worldwide. 1,2 Previous studies on endobiliary RFA showed that local control of a tumor following biliary stent placement improves stent patency and patient survival. 3,4 However, previous studies have reported conflicting results.…”

“…3,4 However, previous studies have reported conflicting results. 1 One reason for this may be related to the device. The device conventionally used for endobiliary RFA is an 8-Fr bipolar catheter with two 8-mm ring electrodes placed 8 mm apart at its terminal segment.…”

Nonsurgical Approaches to Treat Biliary Tract and Liver Tumors

“…Ablation is performed at all sites of stricture for two minutes. Finally, a stent is placed across the treated area and the scope is withdrawn (31)(32)(33). Use of RFA delivered via the percutaneous approach for distal cholangiocarcinoma and PHC has also been described (34)(35)(36)(37).…”

Endoscopic Ultrasound-Guided Antegrade Radiofrequency Ablation and Metal Stenting With Hepaticoenterostomy for Malignant Biliary Obstruction: A Prospective Preliminary Study

“…Endobiliary radiofrequency ablation (RFA) has been reported to control local tumor growth and improve stent patency under endoscopic retrograde cholangiopancreatography (ERCP) guidance ( 9 , 10 ). Although RFA can also be useful for EUS-guided biliary drainage ( 11 ), no study about the effects of RFA under EUS guidance has been conducted.…”