The importance of the “endoscopic oncologist” in the treatment of nonoperable cholangiocarcinoma

Gaddam, Srinivas; Coté, Gregory A.

doi:10.1016/j.gie.2020.06.013

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…No major side effects of both treatments and no increase in adverse events were reported with the combination of ERFA together with adjuvant chemotherapy ( 16 , 52 , 55 ). Therefore, the results of these three studies support our change of approach in patients with locally advanced CCA undergoing biliary drainage, especially if they have a life expectancy of at least 6 months: if possible, they should undergo ERFA before starting adjuvant chemotherapy ( 82 ).…”

Section: Beneficial Effects Of Erfa In the Care Of Unresctable Cholan...mentioning

confidence: 66%

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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Section: Beneficial Effects Of Erfa In the Care Of Unresctable Cholan...mentioning

confidence: 66%

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

et al. 2023

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“…However, more recent work showed that these systemic changes actually represented general inflammatory responses without RFA-specific activation of the adaptive immune system [33]. However, Gaddam and Cote stated that RFA most likely helps patients live longer by keeping their bile duct open [34]. Keeping the bile duct open allows for continuous chemotherapy, while effective chemotherapy likely keeps the bile duct open longer.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Keeping the bile duct open allows for continuous chemotherapy, while effective chemotherapy likely keeps the bile duct open longer. RFA could make the tumor more responsive to radiotherapy or chemotherapy, slowing down local progression and the spread of cancer [34].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Endoluminal radiofrequency ablation with stenting versus stenting alone in patients with malignant biliary obstruction: a meta-analysis of randomized trials

Ramai,

Maida,

Smith

et al. 2024

Endoscopy

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Introduction: Endoluminal radiofrequency ablation (RFA) is a palliative treatment for patients suffering from malignant biliary obstruction. We aimed to conduct a meta-analysis to evaluate the impact of RFA on stent patency, patient survival, and adverse events. Methods: Major databases were searched through November 2023 for patients who underwent stenting with or without RFA for extra-hepatic malignant biliary obstruction. A random effects model was employed for analysis and results conveyed using relative risk ratio with 95% confidence interval. Results: Nine RCTs involving 750 subjects (n=374 RFA plus stent vs. n=376 stent only) with malignant biliary obstruction were included. Meta-analysis revealed similar risks of stent patency at 3 months (RR = 1.01; 95% CI [0.92 – 1.11], I2=4% for RFA plus stenting vs. stent only). Meta-analysis showed improved survival at 6 months (RR = 0.84; 95% CI [0.73 – 0.96], I2=21%, P=0.01 for RFA plus stenting vs. stent only). Subgroup analysis comparing plastic vs uncovered metal stents showed that stent patency was unaffected at 3 months (RR = 1.06; 95% CI [0.91 – 1.23]; I2=17%). Subgroup analysis showed that patients with cholangiocarcinoma experienced an overall survival benefit with RFA plus stenting vs. stent only (P<0.001), however, stent patency remained unaffected (P=0.08). An increased incidence of cholecystitis was noted with RFA plus stent vs. stent only (5.1%; 95% CI [3.1% – 7.8%] vs 0.3%; 95% CI [0.01% – 1.5%], respectively). Conclusion: Combining endoluminal RFA and stenting may improve overall survival in patients with malignant biliary obstruction. RFA did not impact stent patency significantly.

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Contemporary advances in the endoscopic management of cholangiocarcinoma: a review of accomplished milestones and prospective opportunities

Nakshabandi

Lee

2023

Expert Review of Gastroenterology & Hepatology

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The importance of the “endoscopic oncologist” in the treatment of nonoperable cholangiocarcinoma

Cited by 3 publications

References 21 publications

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

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

Endoluminal radiofrequency ablation with stenting versus stenting alone in patients with malignant biliary obstruction: a meta-analysis of randomized trials

Contemporary advances in the endoscopic management of cholangiocarcinoma: a review of accomplished milestones and prospective opportunities

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