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Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications

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Abstract

Background

Biliary radiofrequency ablation (RFA) using the Habib™ EndoHBP catheter is a new endoscopic palliation therapy for malignant biliary obstruction. The aim of this study was to assess the feasibility and safety of this technique.

Methods

In this nationwide retrospective study of prospectively collected clinical data, all patients treated by biliary RFA in Austria between November 2010 and December 2012 were included. Procedure-related complications, adverse events within 30 days post-intervention, stent patency, and mortality rates were investigated.

Results

A total of 58 patients (31 male, 27 female, median age 75 years) underwent 84 RFA procedures at 11 Austrian referral centers for biliary endoscopy. The predominant underlying condition was Klatskin tumor (45 of 58 cases). All 84 RFA procedures were feasible without technical problems. A partial liver infarction was induced by RFA in a 49-year-old Klatskin tumor patient. During 30 days after each RFA procedure, five cases of cholangitis, three cases of hemobilia, two cases of cholangiosepsis, and one case each of gallbladder empyema, hepatic coma, and newly diagnosed left bundle branch block occurred. Median stent patency after last electively performed RFA was 170 days (95 % CI 63–277) and was almost significantly different between metal and plastic stenting (218 vs. 115 days; p = 0.051). Median survival was 10.6 months (95 % CI 6.9–14.4) from the time of the first RFA in each patient and 17.9 months (95 % CI 10.3–25.6) from the time of initial diagnosis.

Conclusions

Except for one severe interventional complication (hepatic infarct), RFA presented as a technically feasible and safe therapeutic option for the palliative treatment of malignant biliary obstruction. The good results of stent patency and survival in this study should be proven in prospective (controlled) trials to further quantify the efficacy of this promising new technique.

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Acknowledgments

The authors would like to acknowledge the following people who substantially contributed to the data collection in the context of this study: Barbara Tribl, Patricia Kump, Wolfgang Vogel, Brigitte Hellmich, Antje Holzäpfel, Michael Wasilewski, Isolde Hinterberger, Franz Siebert, Andreas Maieron, Rainer Schöfl, Johann Pidlich, and Karl Dam.

Disclosures

Werner Dolak, Florian Schreiber, Hubert Schwaighofer, Michael Gschwantler, Wolfgang Plieschnegger, Alexander Ziachehabi, Andreas Mayer, Ludwig Kramer, Andreas Kopecky, Christiane Schrutka-Kölbl, Gernot Wolkersdörfer, Christian Madl, Frieder Berr, Michael Trauner and Andreas Püspök have no conflicts of interest or financial ties to disclose. This study did not receive any public funding or industrial sponsoring.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Werner Dolak, Michael Trauner & Andreas Püspök

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria

    Florian Schreiber

  3. Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria

    Hubert Schwaighofer

  4. Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria

    Michael Gschwantler

  5. Department of Internal Medicine, Barmherzige Brüder, St Veit an der Glan, Austria

    Wolfgang Plieschnegger

  6. Department of Internal Medicine IV, Krankenhaus der Elisabethinen Linz, Linz, Austria

    Alexander Ziachehabi

  7. Department of Internal Medicine II, Landesklinikum, St Pölten, Austria

    Andreas Mayer

  8. Department of Internal Medicine I, Krankenhaus Hietzing, Vienna, Austria

    Ludwig Kramer

  9. Department of Internal Medicine, Landesklinikum Thermenregion Baden, Baden, Austria

    Andreas Kopecky

  10. Department of Internal Medicine IV, Krankenanstalt Rudolfstiftung, Vienna, Austria

    Christiane Schrutka-Kölbl & Christian Madl

  11. Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria

    Gernot Wolkersdörfer & Frieder Berr

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  1. Werner Dolak
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  2. Florian Schreiber
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  3. Hubert Schwaighofer
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  7. Andreas Mayer
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  8. Ludwig Kramer
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  11. Gernot Wolkersdörfer
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  14. Michael Trauner
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  15. Andreas Püspök
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Consortia

for the Austrian Biliary RFA Study Group

Corresponding author

Correspondence to Werner Dolak.

Additional information

This study is conducted for the Austrian Biliary RFA Study Group.

Electronic supplementary material

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Supplementary table Patient characteristics per patient. (DOC 133 kb)

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Dolak, W., Schreiber, F., Schwaighofer, H. et al. Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications. Surg Endosc 28, 854–860 (2014). https://doi.org/10.1007/s00464-013-3232-9

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  • DOI: https://doi.org/10.1007/s00464-013-3232-9

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