Advertisement

CardioVascular and Interventional Radiology

, Volume 37, Issue 1, pp 235–240 | Cite as

Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

  • Madhava Pai
  • Vlastimil Valek
  • Andrasina Tomas
  • Attila Doros
  • Pietro Quaretti
  • Rita Golfieri
  • Cristina Mosconi
  • Nagy Habib
Technical Note

Abstract

Purpose

The major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.

Methods

Nine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.

Results

All nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.

Conclusions

In this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

Keywords

Interventional oncology Radiofrequency ablation Bile duct/gallbladder/biliary Liver/hepatic Pancreas Cancer Stenosis/restenosis Tumour/neoplasm 

Notes

Acknowledgments

This study was supported by the Czech Republic Ministry of Health’s Departmental Research and Development Programme NT11128.

Conflict of interest

Nagy Habib is a shareholder and director of EMcision Limited, the company that developed The Habib™ Percutaneous Endobiliary RF ablation catheter. None of the other authors have a conflict of interest or a financial disclosure to declare.

References

  1. 1.
    Das A, Sivak MV Jr (2000) Endoscopic palliation for inoperable pancreatic cancer. Cancer Control 7:452–457PubMedGoogle Scholar
  2. 2.
    Steel AW, Postgate AJ, Khorsandi S et al (2011) Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc 73:149–153PubMedCrossRefGoogle Scholar
  3. 3.
    Monga A, Gupta R, Ramchandani M, Rao GV et al (2011) Endoscopic radiofrequency ablation of cholangiocarcinoma: new palliative treatment modality (with videos). Gastrointest Endosc 74(4):935–937PubMedCrossRefGoogle Scholar
  4. 4.
    Figueroa-Barojas P, Bakhru MR, Habib N et al (2011) 387 Safety and efficacy of radiofrequency ablation in the management of unresectable bile duct and pancreatic cancer: a novel palliation technique. Gastrointest Surg 73(Suppl):AB127Google Scholar
  5. 5.
    Mizandari M, Pai M, Xi F (2012) Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 36(3):814–819PubMedCrossRefGoogle Scholar
  6. 6.
    Ridtitid W, Rerknimitr R (2012) Management of an occluded biliary metallic stent. World J Gastrointest Endosc 4(5):157–161PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Andersen JR, Sørensen SM, Kruse A et al (1989) Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut 30:1132–1135PubMedCrossRefGoogle Scholar
  8. 8.
    Shepherd HA, Royle G, Ross AP et al (1988) Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg 75:1166–1168PubMedCrossRefGoogle Scholar
  9. 9.
    Loew BJ, Howell DA, Sanders MK et al (2009) 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 70:445–453PubMedCrossRefGoogle Scholar
  10. 10.
    Davids PH, Groen AK, Rauws EA et al (1992) Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340:1488–1492PubMedCrossRefGoogle Scholar
  11. 11.
    Knyrim K, Wagner HJ, Pausch J et al (1993) A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 25:207–212PubMedCrossRefGoogle Scholar
  12. 12.
    O’Brien S, Hatfield AR, Craig PI et al (1995) A three-year follow-up of self-expanding metal stents in the endoscopic palliation of long-term survivors with malignant biliary obstruction. Gut 36:618–621PubMedCrossRefGoogle Scholar
  13. 13.
    Rossi P, Bezzi M, Rossi M et al (1994) Metallic stents in malignant biliary obstruction: results of a multicenter European study of 240 patients. J Vasc Interv Radiol 5:279–285PubMedCrossRefGoogle Scholar
  14. 14.
    Ballinger AB, McHugh M, Catnach SM et al (1994) Symptom relief and quality of life after stenting for malignant bile duct obstruction. Gut 35:467–470PubMedCrossRefGoogle Scholar
  15. 15.
    Kullman E, Frozanpor F, Söderlund C et al (2010) Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc 72:915–923PubMedCrossRefGoogle Scholar
  16. 16.
    Rossi P, Bezzi M, Salvatori FM et al (1997) Clinical experience with covered wallstents for biliary malignancies: 23-month follow-up. Cardiovasc Intervent Radiol 20:441–447PubMedCrossRefGoogle Scholar
  17. 17.
    Hausegger KA, Thurnher S, Bodendorfer G et al (1998) Treatment of malignant biliary obstruction with polyurethane covered wallstents. AJR Am J Roentgenol 170:403–408PubMedCrossRefGoogle Scholar
  18. 18.
    Miyayama S, Matsui O, Terayama T et al (1997) Covered gianturco stents for malignant biliary obstruction: preliminary clinical evaluation. J Vasc Interv Radiol 8:641–648PubMedCrossRefGoogle Scholar
  19. 19.
    Han YM, Jin GY, Lee S et al (2003) Flared polyurethane-covered self-expandable nitinol stent for malignant biliary obstruction. J Vasc Interv Radiol 14:1291–1301PubMedCrossRefGoogle Scholar
  20. 20.
    Kanasaki S, Furukawa A, Kane T et al (2000) Polyurethane-covered Nitinol Strecker stents as primary palliative treatment of malignant biliary obstruction. Cardiovasc Intervent Radiol 23:114–120PubMedCrossRefGoogle Scholar
  21. 21.
    Isayama H, Komatsu Y, Tsujino T et al (2002) Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc 55:366–370PubMedCrossRefGoogle Scholar
  22. 22.
    Isayama H, Komatsu Y, Tsujino T et al (2004) A prospective randomized study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 53:729–734PubMedCrossRefGoogle Scholar
  23. 23.
    Isayama H, Kawabe T, Nakai Y et al (2010) Management of distal malignant biliary obstruction with the ComVi stent, a new covered metallic stent. Surg Endosc 24:131–137PubMedCrossRefGoogle Scholar
  24. 24.
    Ho H, Mahajan A, Gosain S et al (2010) Management of complications associated with partially covered biliary metal stents. Dig Dis Sci 55:516–522PubMedCrossRefGoogle Scholar
  25. 25.
    Cho YK, Kim JK, Kim MY et al (2009) Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology 49:453–459PubMedCrossRefGoogle Scholar
  26. 26.
    Mulier S, Ruers T, Jamart J et al (2008) Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? An update. Dig Surg 25:445–460PubMedCrossRefGoogle Scholar
  27. 27.
    Sutherland LM, Williams JA, Padbury RT et al (2006) Radiofrequency ablation of liver tumors: a systematic review. Arch Surg 141:181–190PubMedCrossRefGoogle Scholar
  28. 28.
    Khorsandi S, Zacharoulis D, Vavra P et al (2008) The modern use of radiofrequency energy in surgery, endoscopy and interventional radiology. Eur Surg 40:204–210CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Madhava Pai
    • 1
  • Vlastimil Valek
    • 2
  • Andrasina Tomas
    • 2
  • Attila Doros
    • 3
  • Pietro Quaretti
    • 4
  • Rita Golfieri
    • 5
  • Cristina Mosconi
    • 5
  • Nagy Habib
    • 1
    • 6
  1. 1.HPB Unit, Department of SurgeryHammersmith Hospital, Imperial CollegeLondonUK
  2. 2.Department of RadiologyUniversity Hospital Brno BohuniceBrnoCzech Republic
  3. 3.Radiology Unit, Department of Transplantation and SurgerySemmelweis UniversityBudapestHungary
  4. 4.Department of RadiologyIRCCS Policlinico San MatteoPaviaItaly
  5. 5.Department of Radiology, Policlinico S. Orsola-MalpighiUniversity of BolognaBolognaItaly
  6. 6.EMcision LimitedLondonUK

Personalised recommendations