Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: A preliminary result

Abstract

AIMTo assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction.METHODSWe specifically report a retrospective study presenting the results of percutaneous intraductal RF in patients with biliary stent occlusion. A total of 43 cases involving biliary stent obstruction were treated by placing an EndoHPB catheter and percutaneous intraductal RF was performed to clean stents. The stent patency was evaluated by cholangiography and follow-up by contrast enhanced computed tomography or ultrasound after the removal of the drainage catheter.RESULTSFollowing the procedures, of the 43 patients, 40 survived and 3 died with a median survival of 80.5 (range: 30-243) d. One patient was lost to follow-up. One patient had the stent patent at the time of last follow-up. Two patients with stent blockage at 35 d and 44 d after procedure underwent percutaneous transhepatic drain insertion only. The levels of bilirubin before and after the procedure were 128 ± 65 μmol/L and 63 ± 29 μmol/L, respectively. There were no related complications (haemorrhage, bile duct perforation, bile leak or pancreatitis) and all patients’ stent patency was confirmed by cholangiography after the procedure, with a median patency time of 107 (range: 12-180) d.CONCLUSIONThis preliminary clinical study demonstrated that percutaneous intraductal RF is safe and effective for the treatment of biliary stent obstruction, increasing the duration of stent patency, although randomized controlled trials are needed to confirm the effectiveness of this approach.

Managing occluded stents in biliary obstruction using radiofrequency ablation combined with 125I-strand brachytherapy

“…It has been the preferred minimally invasive method to treat solid 5) reported a prospective study using a bipolar radiofrequency catheter to clear blocked SEMSs in 9 patients, with a median stent patency of 102.5 days. Subsequently, other investigators have reported techniques using PTCD or ERCP to reopen occluded SEMSs, although retrospective designs limited the statistical power of these results (6)(7)(8)(9). It has been demonstrated that the duration of SEMS patency can be prolonged by ILBT using high-dose-rate 192 Ir.…”

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures

“… 206 In patients developing stent obstruction, few short series have shown the benefit of RFA and balloon sweep in recanalization. 207 208 209 One recent randomized controlled trial from China showed that endoscopic RFA with stenting significantly increases stent patency and survival in patients with extrahepatic cholangiocarcinoma. 210 …”

Updated evidence on the clinical impact of endoscopic radiofrequency ablation in the treatment of malignant biliary obstruction

“…There have been two studies examining the endoscopic approach and three studies examining the percutaneous approach of RFA for occluded SEMS (Table 4). [68][69][70][71][72] Although the primary disease and stricture site vary between studies, the patency period after RFA ranges between 102.5 and 234 days, which is equal to or better than the period of reintervention following procedures other than RFA. 73,74 Only one comparative study reported that the mean stent patency time after reintervention was significantly longer in the RFA group than the control group (119.5 vs. 65.3 days, P = 0.03).…”