Digestive Diseases and Sciences

, Volume 60, Issue 7, pp 2164–2169 | Cite as

Impact of Radiofrequency Ablation on Malignant Biliary Strictures: Results of a Collaborative Registry

  • Reem Z. Sharaiha
  • Amrita Sethi
  • Kristen R. Weaver
  • Tamas A. Gonda
  • Raj J. Shah
  • Norio Fukami
  • Prashant Kedia
  • Nikhil A. Kumta
  • Carlos M. Rondon Clavo
  • Michael D. Saunders
  • Jorge Cerecedo-Rodriguez
  • Paola Figueroa Barojas
  • Jessica L. Widmer
  • Monica Gaidhane
  • William R. Brugge
  • Michel Kahaleh
Original Article

Abstract

Background

Radiofrequency ablation of malignant biliary strictures has been offered for the last 3 years, but only limited data have been published.

Aim

To assess the safety, efficacy, and survival outcomes of patients receiving endoscopic radiofrequency ablation.

Methods

Between April 2010 and December 2013, 69 patients with unresectable neoplastic lesions and malignant biliary obstruction underwent 98 radiofrequency ablation sessions with stenting.

Results

A total of 69 patients (22 male, aged 66.1 ± 13.3) were included in the registry. The etiology of malignant biliary stricture included unresectable cholangiocarcinoma (n = 45), pancreatic cancer (n = 19), gallbladder cancer (n = 2), gastric cancer (n = 1), and liver metastasis from colon cancer (n = 3). Seventy-eight percentage of patients had prior chemotherapy. All strictures were stented post-radiofrequency ablation with either plastic stents or metal stents. The mean stricture length treated was 14.3 mm. There was a statistically significant improvement in stricture diameter post-ablation (p < 0.0001). The likelihood of stricture improvement was significantly greater in pancreatic cancer-associated strictures [RR 1.8 (95 % 1.03–5.38)]. Seven patients (10 %) had adverse events, not linked directly to radiofrequency ablation. Median survival was 11.46 months (6.2–25 months).

Conclusion

Radiofrequency ablation is effective and safe in malignant biliary obstruction and seems to be associated with improved survival.

Keywords

Radiofrequency ablation Biliary obstruction Stent patency Survival Cholangiocarcinoma Pancreatic cancer 

References

  1. 1.
    Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61:1657–1669.PubMedCrossRefGoogle Scholar
  2. 2.
    Lim KH, Chung E, Khan A, et al. Neoadjuvant therapy of pancreatic cancer: the emerging paradigm? Oncologist. 2012;17:192–200.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Vincent A, Herman J, Schulick R, et al. Pancreatic cancer. Lancet. 2011;378:607–620.PubMedCrossRefGoogle Scholar
  4. 4.
    Ramirez-Merino N, Aix SP, Cortes-Funes H. Chemotherapy for cholangiocarcinoma: an update. World J Gastrointest Oncol. 2013;5:171–176.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Kim JH. Endoscopic stent placement in the palliation of malignant biliary obstruction. Clin Endosc. 2011;44:76–86.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Andersen JR, Sorensen SM, Kruse A, et al. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989;30:1132–1135.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    O’Brien S, Hatfield AR, Craig PI, et al. A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. Gut. 1995;36:618–621.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Prat F, Chapat O, Ducot B, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc. 1998;47:1–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Shepherd HA, Royle G, Ross AP, et al. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg. 1988;75:1166–1168.PubMedCrossRefGoogle Scholar
  10. 10.
    Loew BJ, Howell DA, Sanders MK, et al. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc. 2009;70:445–453.PubMedCrossRefGoogle Scholar
  11. 11.
    Lencioni R, Goletti O, Armillotta N, et al. Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial. Eur Radiol. 1998;8:1205–1211.PubMedCrossRefGoogle Scholar
  12. 12.
    Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am. 1995;1:73–81.PubMedGoogle Scholar
  13. 13.
    Shaheen NJ, Overholt BF, Sampliner RE, et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–468.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Vavra P, Dostalik J, Zacharoulis D, et al. Endoscopic radiofrequency ablation in colorectal cancer: initial clinical results of a new bipolar radiofrequency ablation device. Dis Colon Rectum. 2009;52:355–358.PubMedCrossRefGoogle Scholar
  15. 15.
    Figueroa-Barojas P, Bakhru MR, Habib NA, et al. Safety and efficacy of radiofrequency ablation in the management of unresectable bile duct and pancreatic cancer: a novel palliation technique. J Oncol. 2013;2013:1–5.CrossRefGoogle Scholar
  16. 16.
    Steel AW, Postgate AJ, Khorsandi S, et al. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc. 2011;73:149–153.PubMedCrossRefGoogle Scholar
  17. 17.
    National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER). Bethesda, MD: National Cancer Institute; 2011. http://www.seer.cancer.gov. Accessed 7 June 2014.
  18. 18.
    Dolak W, Schreiber F, Schwaighofer H, et al. Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications. Surg Endosc. 2014;28:854–860.PubMedCrossRefGoogle Scholar
  19. 19.
    Schmassmann A, von Gunten E, Knuchel J, et al. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol. 1996;91:654–659.PubMedGoogle Scholar
  20. 20.
    Moss AC, Morris E, Leyden J, et al. Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol. 2007;19:1119–1124.PubMedCrossRefGoogle Scholar
  21. 21.
    Yoon WJ, Ryu JK, Yang KY, et al. A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc. 2009;70:284–289.PubMedCrossRefGoogle Scholar
  22. 22.
    Yoon WJ, Lee JK, Lee KH, et al. A comparison of covered and uncovered wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc. 2006;63:996–1000.PubMedCrossRefGoogle Scholar
  23. 23.
    Moses PL, Alnaamani KM, Barkun AN, et al. Randomized trial in malignant biliary obstruction: plastic vs partially covered metal stents. World J Gastroenterol. 2013;19:8638–8646.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Wagner HJ, Knyrim K, Vakil N, et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy. 1993;25:213–218.PubMedCrossRefGoogle Scholar
  25. 25.
    Saleem A, Leggett CL, Murad MH, et al. Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc. 2011;74:321–327 e1–e3.Google Scholar
  26. 26.
    Hong WD, Chen XW, Wu WZ, et al. Metal versus plastic stents for malignant biliary obstruction: an update meta-analysis. Clin Res Hepatol Gastroenterol. 2013;37:496–500.PubMedCrossRefGoogle Scholar
  27. 27.
    Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of hepatic metastases. Surgery. 1988;103:278–288.Google Scholar
  28. 28.
    Farley DR, Weaver AL, Nagorney DM. “Natural history” of unresected cholangiocarcinoma: patient outcome after noncurative intervention. Mayo Clin Proc. 1995;70:425–429.PubMedCrossRefGoogle Scholar
  29. 29.
    Berr F. Photodynamic therapy for cholangiocarcinoma. Semin Liver Dis. 2004;24:177–187.PubMedCrossRefGoogle Scholar
  30. 30.
    Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc. 1998;47:354–362.PubMedCrossRefGoogle Scholar
  31. 31.
    Choi J, Ryu JK, Lee SH, et al. Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach. Hepatobiliary Pancreat Dis Int. 2012;11:636–642.PubMedCrossRefGoogle Scholar
  32. 32.
    Mihalache F, Tantau M, Diaconu B, et al. Survival and quality of life of cholangiocarcinoma patients: a prospective study over a 4 year period. J Gastrointest Liver Dis. 2010;19:285–290.Google Scholar
  33. 33.
    Alexopoulou A, Soultati A, Dourakis SP, et al. Cholangiocarcinoma: a 7-year experience at a single center in Greece. World J Gastroenterol. 2008;14:6213–6217.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Talreja JP, Degaetani M, Ellen K, et al. Photodynamic therapy in unresectable cholangiocarcinoma: not for the uncommitted. Clin Endosc. 2013;46:390–394. doi:10.5946/ce.2013.46.4.390.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Pereira SP, Ayaru L, Rogowska A, et al. Photodynamic therapy of malignant biliary strictures using meso-tetrahydroxyphenylchlorin. Eur J Gastroenterol Hepatol. 2007;19:479–485.PubMedCrossRefGoogle Scholar
  36. 36.
    Zoepf T, Jakobs R, Arnold JC, et al. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol. 2005;100:2426–2430.PubMedCrossRefGoogle Scholar
  37. 37.
    Chahal P, Baron TH. Endoscopic palliation of cholangiocarcinoma. Curr Opin Gastroenterol. 2006;22:551–560.PubMedCrossRefGoogle Scholar
  38. 38.
    Bruha R, Petrtyl J, Kubecova M, et al. Intraluminal brachytherapy and self expandable stents in nonresectable biliary malignancies: the question of long-term palliation. Hepatogastroenterology. 2001;48:631–637.PubMedGoogle Scholar
  39. 39.
    Montemaggi P, Costamagna G, Dobelbower RR, et al. Intraluminal brachytherapy in the treatment of pancreas and bile duct carcinoma. Int J Radiat Oncol Biol Phys. 1995;32:437–443.PubMedCrossRefGoogle Scholar
  40. 40.
    Ishii H, Furuse J, Nagase M, et al. Relief of jaundice by external beam radiotherapy and intraluminal brachytherapy in patients with extrahepatic cholangiocarcinoma: results without stenting. Hepatogastroenterology. 2004;51:954–957.PubMedGoogle Scholar
  41. 41.
    Kuvshinoff BW, Armstrong JG, Fong Y, et al. Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy. Br J Surg. 1995;82:1522–1525.PubMedCrossRefGoogle Scholar
  42. 42.
    Vallis KA, Benjamin IS, Munro AJ, et al. External beam and intraluminal radiotherapy for locally advanced bile duct cancer: role and tolerability. Radiother Oncol. 1996;41:61–66.PubMedCrossRefGoogle Scholar
  43. 43.
    Foo ML, Gunderson LL, Bender CE, et al. External radiation therapy and transcatheter iridium in the treatment of extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys. 1997;39:929–935.PubMedCrossRefGoogle Scholar
  44. 44.
    Gerhards MF, van Gulik TM, Gonzalez Gonzalez D, et al. Results of postoperative radiotherapy for resectable hilar cholangiocarcinoma. World J Surg. 2003;27:173–179.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Reem Z. Sharaiha
    • 1
  • Amrita Sethi
    • 2
  • Kristen R. Weaver
    • 1
  • Tamas A. Gonda
    • 2
  • Raj J. Shah
    • 3
  • Norio Fukami
    • 3
  • Prashant Kedia
    • 1
  • Nikhil A. Kumta
    • 1
  • Carlos M. Rondon Clavo
    • 1
  • Michael D. Saunders
    • 4
  • Jorge Cerecedo-Rodriguez
    • 1
  • Paola Figueroa Barojas
    • 1
  • Jessica L. Widmer
    • 1
  • Monica Gaidhane
    • 1
  • William R. Brugge
    • 5
  • Michel Kahaleh
    • 1
  1. 1.Division of Gastroenterology and HepatologyWeill Cornell Medical CollegeNew YorkUSA
  2. 2.GastroenterologyColumbia University Medical CenterNew YorkUSA
  3. 3.GastroenterologyUniversity of ColoradoDenverUSA
  4. 4.GastroenterologyUniversity of WashingtonSeattleUSA
  5. 5.GastroenterologyMassachusetts General HospitalBostonUSA

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