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

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.

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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.

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Correspondence to Nagy Habib.

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Pai, M., Valek, V., Tomas, A. et al. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results. Cardiovasc Intervent Radiol 37, 235–240 (2014). https://doi.org/10.1007/s00270-013-0688-x

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Keywords

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