Abstract
ObjectivesTo determine the safety and feasibility of intraductal radiofrequency ablation (RFA) followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion.MethodsFourteen patients with malignant biliary obstruction and blocked metal stents were studied retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were monitored clinically and radiologically. The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.ResultsCombination treatment was successful for all patients. There were no severe complications during RFA or local treatments. All patients had stent patency restored, with a decline in serum bilirubin. Three patients had recurrent jaundice by 195, 237 and 357 days; two patients underwent repeat intraductal RFA; and one required an internal-external biliary drain. The average stent patency time was 234 days (range 187-544 days). With a median follow-up of 384 days (range 187-544 days), six patients were alive, while eight had died. There was no mortality at 30 days. The 3, 6, 12 and 18 month survival rates were 100%, 100%, 64.3% and 42.9%, respectively.ConclusionIntraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.
Highlights
In patients suffering with unresectable malignant biliary obstruction with a life expectancy longer than 3 months, stent placement by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiodrainage (PTCD) is the standard technique to ensure continued biliary drainage [1, 2]
Transcatheter arterial chemoembolization (TACE) following PTCD and stent implantation may significantly contribute to the survival time of patients with malignant biliary obstruction, and may improve stent patency [10, 11]
We extended our analysis to explore if locoregional tumor treatments including TACE and intra-arterial chemotherapy with embolization of tumor-feeding arteries following intraductal radiofrequency ablation (RFA) could increase the survival time for these patients
Summary
In patients suffering with unresectable malignant biliary obstruction with a life expectancy longer than 3 months, stent placement by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiodrainage (PTCD) is the standard technique to ensure continued biliary drainage [1, 2]. In patients with malignant biliary obstruction, the median patency time of a metallic biliary stent is 6–9 months [7]. Patients experience complications from recurrent biliary obstruction due to local tumor progression, despite intraductal RFA and drainage. Transcatheter arterial chemoembolization (TACE) following PTCD and stent implantation may significantly contribute to the survival time of patients with malignant biliary obstruction, and may improve stent patency [10, 11]
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