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Endobiliary Radiofrequency Ablation Using a Short-Type Balloon Enteroscope in Patients with Surgically Altered Anatomy

Abstract

Background

Endoscopic radiofrequency ablation (RFA) is expected to prolong stent patency for malignant biliary obstruction (MBO). However, its feasibility when used in conjunction with a balloon enteroscope (BE) in patients with surgically altered anatomy (SAA) remains unknown.

Aims

This study aimed to investigate the feasibility of RFA combined with metal stent insertion under BE guidance for MBO in patients with SAA.

Methods

Thirty-seven patients who underwent treatment between October 2016 and January 2021 and met the eligibility criteria were investigated retrospectively. Study outcomes included technical and clinical success, recurrent biliary obstruction (RBO), and other adverse events besides RBO associated with RFA with metal stent placement using BE.

Results

Technical and clinical success rates were 100% (37/37) each. The rates of early and late adverse events were 8.1% (3/37) and 8.1% (3/37), respectively. RBO occurred in 32.4% (12/37) of the patients, and the median time to RBO was 296 days. The cause of RBO was ingrowth in eight patients, overgrowth in three patients, and indeterminate in one patient. All reinterventions for RBO were successful using the BE approach; all ingrowths, except one, were recanalized using additional RFA without additional stent placement. The frequency of reintervention-related adverse events was 9.1% (1/11). The median time to RBO after reintervention was 166 days.

Conclusions

This study demonstrated the technical safety and feasibility as well as good long-term outcomes of endobiliary RFA combined with metal stent placement under BE guidance. This approach may be a useful option for treating MBO in patients with SAA.

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Acknowledgments

None.

Funding

No funding was received for this study.

Author information

Affiliations

Authors

Contributions

T.I.: conception and design, data acquisition, analysis and interpretation, and drafting and revision of the manuscript. M.I., R.K., K.S., S.K., Y.K., T.O., Y.S., Y.N., K.I., M.Y.: data interpretation, and revision of the manuscript.

Corresponding author

Correspondence to Tadahisa Inoue.

Ethics declarations

Conflict of interest

Tadahisa Inoue received honoraria from Boston Scientific Japan and Japan Lifeline Co., Ltd, outside the submitted work. All other authors have no financial relationships relevant to this publication to disclose.

Ethical approval

Aichi Medical University Hospital’s institutional review board approved this study (Approval number: 2018-H192). The study was conducted in accordance with the principles of the Declaration of Helsinki.

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Inoue, T., Ibusuki, M., Kitano, R. et al. Endobiliary Radiofrequency Ablation Using a Short-Type Balloon Enteroscope in Patients with Surgically Altered Anatomy. Dig Dis Sci (2021). https://doi.org/10.1007/s10620-021-07224-7

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Keywords

  • Balloon enteroscope
  • Malignant biliary obstruction
  • Radiofrequency ablation
  • Self-expandable metal stent
  • Surgically altered anatomy