Clinical value of the transluminal radiofrequency catheter ablation for malignant esophageal obstruction

Abstract

Objective To investigate the clinical value of the transluminal radiofrequency catheter ablation (RFCA) for malignant esophageal obstruction. Methods The retrospective cross-sectional descriptive study was conducted. The clinicopathological data of 52 patients with malignant esophageal obstruction who underwent transluminal RFCA at the Affiliated Hospital of Shandong Academy of Medical Science between March 2013 and March 2016 were collected. Patients received the bipolar radiofrequency ablation (RFA) under dual-channel endoscopy and X-ray. Observation indicators: (1) intra- and post-operative situations: operation situations, operation time, time of RFA, postoperative complications and duration of postoperative hospital stay, (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the subsequent treatment, survival of patients and recurrence of esophageal obstruction up to June 2016. Measurement data with normal distribution were represented as average (range). Results (1) Intra- and post-operative situations: 52 patients underwent successful RFCA, without the occurrence of aspiration, asphyxia, hemorrhage and perforation. Esophageal obstruction was disappeared after treatment, X-ray findings showed a smooth esophagus. Average operation time and time of RFCA were respectively 58 minutes (range, 20-71 minutes) and 23 minutes (range, 8-42 minutes). Patients took liquid food at postoperative day 2 and normal food at postoperative day 3, without the sensations of esophageal obstruction. Of 52 patients, 1 with postoperative hypotension returned to normal level through rehydration and increasing blood volume. Five patients with postoperative substernal pain were improved after 2-day symptomatic treatment. And other 46 patients didn′t have postoperative complications. Average duration of postoperative hospital stay was 3 days (range, 1-5 days). (2) Follow-up: 52 patients were followed up for 3-24 months, with a median time of 13 months. Of 52 patients, 17 underwent single intravascular interventional therapy, 15 underwent intravascular interventional therapy combined with single systemic chemotherapy, 14 underwent single systemic chemotherapy and other 6 didn′t undergo antineoplastic therapy. During the follow-up, 9 patients didn′t have esophageal obstruction and 26 were complicated with esophageal obstruction again. Esophageal obstruction of 26 patients was respectively occurred at 3-8 months postoperatively, 20 patients were improved after bipolar transluminal RFCA under dual-channel endoscopy and X-ray and 6 received parenteral nutrition support therapy due to extreme exhaustion. Seventeen patients died of cachexia caused by terminal malignant tumors. Conclusion Transluminal RFCA is safe and effective for malignant esophageal obstruction, with a good short-term outcome. Key words: Esophageal neoplasms; Obstruction, malignant; Radiofrequency catheter ablation, transluminal