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Initial Experience of ERCP-Guided Radiofrequency Ablation as the Primary Therapy for Inoperable Ampullary Carcinomas

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Abstract

Background

Endoscopic ablation of duodenal ampullary malignancy has not been fully assessed.

Aims

The study aimed to evaluate the efficacy and safety of Endoscopic retrograde cholangiopancreatograpy (ERCP)-guided radiofrequency ablation (RFA) for inoperable ampullary cancer.

Methods

Patients with inoperable ampullary cancer underwent ERCP-guided RFA from January 2012 to August 2017. RF energy (7–10 W) was delivered using bipolar RFA electrodes under endoscopic guidance. RFAs were repeated every 1–3 months until visible tumor was eliminated. All patients were followed up till June 2018, during which any biliary event was noted and managed endoscopically.

Results

Twenty-three patients underwent a median of two RFA sessions (range 1–6) at a median interval of 56 (range 35–90) days. Among 18 (78.3%) patients who received endoscopic re-evaluations, nine patients showed no remaining lesion and nine showed more than 50% tumor size reduction. During a median follow-up duration of 517 days (range 60–1836 days), eight (34.8%) patients required endoscopic re-interventions. The re-intervention rate at 6 months after RFA was 36.8%. Twelve patients were alive, among whom six required no biliary stenting. The accumulative mean survival was 1081 (95% CI 757.8–1404.0) days. RFA-related adverse events occurred in four cases (7.7%) including mild pancreatitis (1), bleeding (1), and late distal biliary stenosis (2).

Conclusion

This pilot study shows that ERCP-guided RFA is safe to use and able to reduce tumor volume and re-interventions in patients with inoperable ampullary cancer.

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Acknowledgments

This study was partially supported by funding from the Shanghai Outstanding Medical Academic Leader Program (2015-83).

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Authors and Affiliations

  1. Department of Gastroenterology and Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, 200438, China

    Bing Hu, Bo Sun, Dao-Jian Gao, Jun Wu, Xin Ye, Ming-Xing Xia & Tian-tian Wang

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  1. Bing Hu
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  2. Bo Sun
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  3. Dao-Jian Gao
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  4. Jun Wu
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  5. Xin Ye
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  6. Ming-Xing Xia
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  7. Tian-tian Wang
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Contributions

BH performed conception and design of the study, clinical practice, and critical revision of the article. BS drafted the article. JW contributed to analysis and interpretation of data. BH, JW, DG, XY, MX, and TW were involved in clinical practice and data collection. All authors approved the publication of this article.

Corresponding author

Correspondence to Bing Hu.

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Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent

The study was approved by the institutional review board of the hospital. Patients provided written informed consent to participate in the study before the endoscopic radiofrequency ablation procedure.

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Hu, B., Sun, B., Gao, DJ. et al. Initial Experience of ERCP-Guided Radiofrequency Ablation as the Primary Therapy for Inoperable Ampullary Carcinomas. Dig Dis Sci 65, 1453–1459 (2020). https://doi.org/10.1007/s10620-019-05849-3

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  • DOI: https://doi.org/10.1007/s10620-019-05849-3

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