Digestive Diseases and Sciences

, Volume 60, Issue 11, pp 3449–3455 | Cite as

Analysis of Endoscopic Radiofrequency Ablation of Biliary Malignant Strictures in Pancreatic Cancer Suggests Potential Survival Benefit

  • Yiannis Kallis
  • Natalie Phillips
  • Alan Steel
  • Harry Kaltsidis
  • Panagiotis Vlavianos
  • Nagy Habib
  • David Westaby
Original Article

Abstract

Background

Pancreatic carcinoma is often inoperable, carries a poor prognosis, and is commonly complicated by malignant biliary obstruction. Phase I/II studies have demonstrated good safety and early stent patency using endoscopic biliary radiofrequency ablation (RFA) as an adjunct to self-expanding metal stent (SEMS) insertion for biliary decompression.

Aim

To analyze the clinical efficacy of endobiliary RFA.

Methods

Retrospective case–control analysis was carried out for 23 patients with surgically unresectable pancreatic carcinoma and malignant biliary obstruction undergoing endoscopic RFA and SEMS insertion and 46 controls (SEMS insertion alone) in a single tertiary care center. Controls were stringently matched for age, sex, metastases, ASA/comorbidities. Survival, morbidity, and stent patency rates were assessed.

Results

RFA and control groups were closely matched—ASA 2.35 ± 0.65 versus 2.54 ± 0.50, p = 0.086; metastases 9/23 (39.1 %) versus 18/46 (39.1 %), p = 0.800; chemotherapy 16/23 (69.6 %) versus 24/46 (52.2 %), p = 0.203. Median survival in RFA group was 226 days (IQR 140–526 days) versus 123.5 days (IQR 44–328 days) in controls (p = 0.010). RFA was independently predictive of survival at 90 days (OR 21.07, 95 % CI 1.45–306.64, p = 0.026) and 180 days (OR 4.48, 95 % CI 1.04–19.30, p = 0.044) in multivariate analysis. SEMS patency rates were equivalent in both groups. RFA was well tolerated with minimal side effects.

Conclusions

Endoscopic RFA is a safe and efficacious adjunctive treatment in patients with advanced pancreatic malignancy and biliary obstruction and may confer early survival benefit. Randomized prospective clinical trials of this new modality are mandated.

Keywords

Biliary metal stent Malignant biliary stricture Therapeutic endoscopy Obstructive jaundice 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Yiannis Kallis
    • 1
  • Natalie Phillips
    • 1
  • Alan Steel
    • 2
  • Harry Kaltsidis
    • 1
  • Panagiotis Vlavianos
    • 1
  • Nagy Habib
    • 3
  • David Westaby
    • 1
  1. 1.HPB Unit/Department of Gastroenterology, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK
  2. 2.Department of GastroenterologyChelsea and Westminster Hospital NHS TrustLondonUK
  3. 3.Academic Department of Surgery, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK

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