Interventional radiofrequency ablation: A promising therapeutic modality in the management of malignant biliary and pancreatic duct obstruction

Abstract

Background: Malignant biliary and/or pancreatic obstruction has often encountered in the advanced stages of periampullary and cholangicarcinomas. HabibTM Radiofrequency (RF) ablation has been successfully used in the management of various cancers of liver and pancreas. Percutaneous HPB probe (EMcision Ltd, London, UK) is a new addition to this class of tools. It is an endoluminal Radiofrequency (RF) catheter which works on the principle of ablation and induces coagulative necrosis to recanalize the obstructed duct. The aim of this study is to address the technical details of canalization, feasibilities and outcomes of percutaneous endo-luminal Radiofrequency (RF) catheter in patients with unresectable malignancy with obstructed bile and pancreatic duct (PD).Material and Method: A total of 134 patients with inoperable malignant obstruction of biliary and PD underwent RF based percutaneous endoluminal RF ablation in a tertiary referral centre between December 15th, 2010 to August 7th, 2015. This device was used in a sequential manner with an intent to recanalize the obstructed. Following the initial catheter drainage of the duct, subsequent percutaneous endobiliary RF ablation, the metallic stent was placed to recanalize the obstructed bile and PD secondary to unresectable malignancy under real-time fluoroscopic guidance.Results: The percutaneous RF based ablation of obstructed bile duct and PD with metallic stent placement was successfully achieved in 130 (97.01%) cases. The three failures were noted in cases of biliary obstruction whilst, one with PD obstruction. The patency restored in 124 and patients, where the procedure was successfully completed and revealed clinical improvement reported.Conclusion: The percutaneous endoluminal RF based ablation of obstructed duct with metallic stent placement appeared to be a safe, effective procedure and may improve survival in patients with advanced stage cancer presenting with biliary and PD obstruction. Considering the above mentioned evidence, this modality may stand ahead of stenting alone. This could be considered as viable modality in management of such patients where very limited treatment options are available.

Stent placement combined with intraluminal radiofrequency ablation and hepatic arterial infusion chemotherapy for advanced biliary tract cancers with biliary obstruction: a multicentre, retrospective, controlled study

“…Monga confirmed the disappearance of tumour blood vessels and lumen enlargement after intra-RFA [ 25 ]. Several studies have reported the clinical efficacy, safety, and survival benefit of intra-RFA for MBO [ 13 , 15 , 26 ]. In a prospective, randomised trial comparing intra-RFA + stent placement with stent placement alone for unresectable extrahepatic cholangiocarcinoma with BO, the combined treatment significantly improved the overall mean survival time and mean stent patency period (6.8 vs. 3.4 months; p = 0.02; 13.2 ± 0.6 vs. 8.3 ± 0.5 months; p < 0.001) [ 27 ].…”

Role of Radiofrequency Ablation in the Management of Unresectable Pancreatic Cancer

“…The tumor size remained stable in 55.6% (10/18) of patients at 1 month of follow up abdominal CT scan, and increased in 44.4% (8/18) patients which raised question about the effectiveness of percutaneous RFA ( 30 ). Mizandari et al performed percutaneous intraluminal RFA coupled with stent placement was used in 134 patients with malignant obstructions of bile and pancreatic ducts (32 patients with pancreatic adenocarcinoma) and reported a 97% success rate of procedure with only two patients experienced procedural technique related adverse events (contrast extravasation) following RFA ( 36 ).…”

“…RFA with subsequent stent placement has been successfully used to re-canalize biliary or pancreatic ducts that were obstructed by unresectable tumors ( 36 ). Indeed, ductal decompression with stenting is considered standard of care in patients with malignant obstruction of biliary or pancreatic ducts due to unresectable tumors, however, stents are often prone to occlusion ( 23 , 24 , 48 – 50 ).…”

Current Endoscopic Management of Malignant Biliary Stricture

“…Endoscopic drainage has a low risk of complications, but it is associated with a high probability of recurrent biliary obstruction [32] when compared with surgical bypass. After an endobiliary radiofrequency ablation (RFA) system was applied to biliary malignant obstructions, series intra-luminal RFA and self-expanding metal stents (SEMS) became a safe treatment choice with better intervention-free survival compared to SEMS alone [33][34][35]. Percutaneous trans-hepatic cholangiography and drainage (PTCD) should be reserved for unsuccessful endoscopic procedures in patients with MDBO.…”