Radiofrequency Ablation In Management Research Articles

S674 Efficacy and Safety of Radiofrequency Ablation in Management of Patients With Low-Grade Dysplasia in Barrett's Esophagus: A Systematic Review and Meta-Analysis

S674 Efficacy and Safety of Radiofrequency Ablation in Management of Patients With Low-Grade Dysplasia in Barrett's Esophagus: A Systematic Review and Meta-Analysis

S3348 Safety and Efficacy of Biliary Radiofrequency Ablation in Management of Ampullary Lesions

S3348 Safety and Efficacy of Biliary Radiofrequency Ablation in Management of Ampullary Lesions

Analysis of 5 years' experience of a head and neck surgeon with radiofrequency ablation for benign thyroid nodule

PurposeThis study reports the long-term efficacy, safety, complications and management of radiofrequency ablation (RFA) for benign thyroid nodule performed over 5 years by a head and neck surgeon. Materials and methodsWe studied 287 consecutive patients who underwent RFA between March 2011 and January 2021. Pre- and postoperative thyroid nodule volumes were measured and volume reduction rate was calculated using ultrasonography (USG). Subjective symptom scores and cosmetic scores were investigated. Complications and their managements were analyzed. Complications and their management were investigated. Follow-up USG was performed at 6 and 12 months after RFA, and annually thereafter. ResultsThe mean volume reduction was 75.2 ± 23.8 % after 6 months and 91.9 ± 14.8 % after 5 years. All of nodule volume, and the cosmetic and symptom scores, decreased significantly postoperatively, and these scores were maintained to 5 years. Minor complications occurred in 15 of 287 (5.2 %) patients; there were no major complications. Injection laryngoplasty was performed for three patients with vocal cord paralysis. Two patients underwent open thyroid surgery because of nodule regrowth. ConclusionsRFA is a safe and effective treatment without major complication for more than five years. Minor complications were managed by the head-and-neck surgeon personally.

Efficacy of Radiofrequency Ablation in Chronic Pain Management

The aim of this study is to determine the efficacy of radiofrequency ablation in management of chronic pain. Radiofrequency ablation in pain management was done in 21 patients who were experiencing chronic pain in different regions of the body. Patients were divided into three groups according to region of pain i.e. chronic lower back pain, trigeminal neuralgia, and osteoarthritis. Pre-treatment and Post-treatment pain score were taken with numeric rating scale (NRS). Denervation was achieved in the pain originating region with the help of Cosman RFG-1A radiofrequency generator under fluoroscopy obtained from Axiom Artis U. The comparison between pre pain score and post pain score revealed the pain was almost nullified in 52% of the patients whereas in 33% it was reduced to tolerable levels and 15% still had some trouble, though pain was slightly reduced as compared before ablation. Radiofrequency ablation alleviated the pain in cases where oral medications were not enough and surgical management could not be done or had a failure.

Radiofrequency ablation in the management of primary hepatic and biliary tumors.

In the United States, 80%-90% of primary hepatic tumors are hepatocellular carcinomas and 10%-15% are cholangiocarcinomas (CCA), both with high mortality rate, particularly CCA, which portends a worse prognosis. Traditional management with surgery has good outcomes in appropriately selected patients; however, novel ablative treatment options have emerged, such as radiofrequency ablation (RFA), which can improve the prognosis of both hepatic and biliary tumors. RFA is aimed to generate an area of necrosis within the targeted tissue by applying thermal therapy via an electrode, with a goal to completely eradicate the tumor while preserving surrounding healthy tissue. Role of RFA in management of hepatic and biliary tumors forms the focus of our current mini-review article.

Repeat hepatectomy versus radiofrequency ablation in management of recurrent hepatocellular carcinoma: an average treatment effect analysis.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver with high rates of recurrence post-resection. Repeat hepatectomy (RH) and radiofrequency ablation (RFA) are the mainstays for managing recurrent HCC following initial curative resection. This retrospective study aims to determine the average treatment effect of RH and RFA in patients with recurrent HCC. From 2000 to 2016, a total of 219 consecutive patients with recurrent HCC who underwent either RH or RFA were included in the study. The analysis was performed using inverse probability of treatment weighting (IPTW), and propensity score-matched (PSM) methods. The minor and major post-operative morbidity after propensity score-matched analysis for the RH group was 30.0% and 6.0%, respectively, and 19.2% and 0.0% (p = 0.1006), respectively, for the RFA group. After propensity score matching, the median OS for RH and RFA was 85.5 (IQR, 33.5-not reached) and 53.3 months (IQR, 27.5-not reached) (p = 0.8474), respectively. There was no significant difference in 90-day mortality between both groups (p = 0.1287). RH showed improved long-term overall survival over RFA at the third [71.3% versus 65.7% (p = 0.0432)], fifth [59.9% versus 45.4% (p = 0.0271)] and tenth [35.4% versus 32.2% (p = 0.0132)] year follow-up, respectively. Median time to recurrence was 11.1 (IQR, 5.0-33.2) and 28.0 months (IQR, 9.1-not reached) (p = 0.0225) for the RFA and RH group, respectively. RH confers a late survival benefit compared with RFA for patients with recurrent HCC despite a higher morbidity rate.

Radiofrequency ablation in management of simple non-parasitic liver cysts

Purpose. Comparison of the long-term outcomes of the treatment of simple liver cysts by traditional and modified RFA methods.Materials and methods. From 2015 to 2018, US-guided RF ablation was used to treat simple nonparasitic hepatic cysts in 14 patients. There were 15 operated cysts in total. 7 patients of group A underwent standard RFA session without temperature restrictions. 7 patients of group B with localization of cysts closely to large vessels and bile ducts or the area of portal fissure, underwent RFA at 60 °C with preinjection of 10% NaCl solution into the cyst cavity. During the intervention, the temperature of the surrounding electrode tissue and the exposure time were recorded.Results. All patients underwent interventions satisfactorily; no complications were observed. In group A, the mean cyst diameter was 50.3 ± 15.2 mm, and the mean initial cyst volume was 77.09 ± 23.2 cm3. In group B, the mean cyst diameter was 61.8 ± 14.9 mm, and the mean initial cyst volume was 137.8 ± 39.2 cm3. After 3 months, the overall decrease in the volume of operated cysts on CT was in group A – 27.1%, in group B – 50.6%; after 6 months – 49.8% and 60.4%, respectively. After 12 months, similar indicators in group A amounted to 64.2%, in group B – 79.2%. 1.5 years after surgery, the volume of operated cysts in group A decreased by 65.2%, in group B by 91.2%; and after 2 years – by 68.9% and 93.6%, respectively. The total decrease of cyst volume at the last control in group B was 24.7% more than in group A. The decrease in cyst volume by more than 50% was noted in group A in 37.5%, in group B – in 85.7%. Complete reduction of the cyst cavity was noted in group A in 25%, in group B in 28.5%. The difference in the decrease of the cyst volumes between the groups after 2 years is statistically significant (p = 0.03), thus it can be concluded that a significantly more pronounced decrease in cyst volumes was observed in group B than in group A.Conclusion. Preinjection into the cystic cavity of a 10% solution of NaCl allowed to achieve a more pronounced decrease of the cystic cavities with the lower RFA temperature regime. At a temperature of 60 °C, the thermal damage minimally spreads to adjacent healthy liver tissue andis sufficient for the radical treatment of the cystic cavity. This makes possible to use the modified RFA method for cysts, located close to the large vessels and bile ducts.

Comparative analysis of early outcomes of radiofrequency ablation and 1470-nm endovenous laser ablation in the treatment of great saphenous vein insufficiency

Background: Minimally invasive Endovenous Thermal Ablation Therapy has revolutionized the treatment of varicose veins. Comparison of radiofrequency ablation (RFA) and Endovenous Laser Ablation (EVLA) needs to be more elaborated in the context of better management of patients. The objective of this study is to compare 1470-nm endovenous laser Ablation (EVLA) and radiofrequency ablation (RFA) in the treatment of patients with great saphenous vein Insufficiency. Methods: There were 100 consecutive patients presenting to our department with a great saphenous vein insufficiency treated between June 2018 and June 2019 who were included in the study. The first randomly selected 50 patients (group 1) received 1470-nm EVLA and the other 50 patients (group 2) received RFA. Patients were assessed on the second day, the first week, and the first month in terms of post-operative complications, return to routine activity and work, and postoperative pain. Results: 50 patients were allocated to each group. There was no statistically significant difference between two groups in terms of postoperative pain. Time to return to daily activity was 5.1 ± 1.12 hours in the EVLA group and 6.9 ± 0.93 hours in the RFA group (P = 0.001), whereas time to return to work was 6.7 ± 1.03 days in the EVLA group and 7.4 ± 1.07 days in the RFA group (P = 0.003). Minor complications in EVLA and RFA group were ecchymosis 26% and 32% (P = 0.509) edema 24% and 34% (P = 0.271), and induration 14% and 22% (P = 0.298), respectively. No major complication were observed in any group. Conclusion: EVLA using a 1470-nm radial fiber is an acceptable and efficacious treatment option over RFA in management of symptomatic varicose veins patients in terms of early outcome. However, long term follow up and more studies on larger populations are required to establish the superiority of either method.

Sphenopalatine ganglion radiofrequency ablation for management of atypical trigeminal neuralgia

Sphenopalatine ganglion radiofrequency ablation for management of atypical trigeminal neuralgia

680 Endoscopic Radiofrequency Ablation for Management of Occluded Metal Stents in Malignant Distal Biliary Obstruction

680 Endoscopic Radiofrequency Ablation for Management of Occluded Metal Stents in Malignant Distal Biliary Obstruction

Radiofrequency ablation for management of malignant biliary obstruction: a single-center experience and review of the literature

ABSTRACTBackground: Radiofrequency ablation (RFA) causes coagulative necrosis of tissue and may be beneficial prior to biliary stenting. We report our experience using RFA for malignant biliary obstruction and review the literature.Methods: Retrospective analysis of all patients undergoing RFA for malignant biliary obstruction over the last two years. Success, complications and re-intervention following RFA were assessed. Controls were age, sex and disease matched who had stenting alone.Results: 31 patients were included and 15 patients underwent biliary RFA prior to stenting (median age 78 years, 8 females). 14 patients had pancreatic cancer, 13 cholangiocarcinoma (6 hilar lesions) and 4 malignant disease invading the bile duct. Adverse events included acute pancreatitis (n = 2) and bacteremia in (n = 1). Median duration of intervention free survival was 220 days in the RFA group compared to 106.5 days in controls (hazard ratio 2.4, 95% CI 1.1 – 5.3, p = 0.025). Multivariable Cox proportional hazard analysis showed survival was associated with RFA (hazard ratio 2.55, 95% CI 1.09–5.96, p = 0.026) but not age, site or type of malignancy.Conclusion: Biliary RFA is a technically feasible with a low adverse event rate and is associated with increased survival. Multi-centre randomized controlled trials are required.

Conventional surgery versus endovenous radiofrequency ablation in management of patients with primary varicose veins

Conventional surgery versus endovenous radiofrequency ablation in management of patients with primary varicose veins

Comparison of Safety, Efficacy, and Long-term Outcomes of Radiofrequency Ablation (RFA) for Treatment of Dysplastic Barrettʼs in a Low-Volume Center Compared to Published Standards from High-Volume Centers

Introduction: Radiofrequency ablation (RFA) is an established treatment modality for Barrett's esophagus with dysplasia (BE-D), favored given its cost effectiveness, low recurrence and adverse event rates, and greater patient satisfaction. Although it is practiced universally, comparative data between low-volume versus high-volume centers is lacking. The aim of our study is to evaluate safety, efficacy and long term outcomes of RFA in a low-volume center, and compare it to existing published values from highvolume centers, in an attempt to improve quality and establish better practice standards. Methods: Our IRB approved retrospective study involved all patients enrolled in Barrett's RFA program at our institution between 2010 and 2014. Results: A total of 24 patients were identified, but data on 4 was partly unavailable due to change of endoscopy software during this period, and were hence excluded.Charts of 20 patients (M: F=18:2, Caucasian:Black=16:4) were finally reviewed. The common symptoms for EGD referral included heartburn (85%), water brash (15%), dysphagia (15%), nausea (10%) and GI bleeding (10%). The biopsies showed high-grade dysplasia (HGD) in 10, low-grade dysplasia (LGD) in 9 and one patient had mix of LGD-HGD. 4/20 patients had nodules, who underwent EMR but none had adenocarcinoma. No other treatment was attempted on any of these patients before RFA. The number of RFA sessions needed for complete resolution of BE was variable - 1 session (1 patient), 2 sessions (7 patients), 3 sessions (5 patients), 4 sessions (4 patients), 5 sessions (1 patient) and 6 sessions (1 patient). One patient was lost to follow-up after 5thsession. Circumferential ablation was used in 80% of the patients in first round, 14% in second round and only focal therapy was needed in patients after that. The RFA treatments were welltolerated, with transient nausea being the commonest post-procedure complaint (50%), followed by mild chest discomfort and dysphagia (16.7%). None of the patients had any serious complications including perforation or bleeding. None of the patients developed adenocarcinoma of the esophagus during the course of follow-up till date. Conclusion: RFA was found to be safe and equally efficacious in a low-volume center, as is in highvolume centers, and long term outcomes were reassuring. These results call for greater use of RFA in management of dysplastic BE, in non-referral centers also.

Cost-effectiveness analysis of radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) in patients with isolated hepatic metastases from colorectal cancer (CRC).

639 Background: Systemic therapy combined with surgery may prolong survival of patients with isolated hepatic metastases from CRC, however, only 10-25% are resectable. We applied a Markov model to estimate and compare cost effectiveness for the two competing treatments of SBRT and RFA in management of unresectable isolated hepatic metastases. Methods: We developed a multistate Markov decision model with probabilistic sensitivity analysis to simulate a randomized controlled trial for SBRT and RFA and compare respective cost effectiveness (in dollars per quality adjusted life years, or QALY). Model assumptions were based on extensive literature search of utilities and recurrence risks, including published data from our institution. Costs were taken from the 2013 Medicare reimbursement tables. In order to reflect reported patient selection variability across literature, two mortality rates due to hepatic metastases were considered for both treatment modalities: 50% probability of death in 1.5 years and 60% in 5 years. Sensitivity analysis was performed to model uncertainty in these parameters. Results: For patients with 5-year life expectancy, Markov cohort analysis demonstrated QALY-adjusted survival advantage of SBRT over RFA with QALY 4.35 vs. 3.89 respectively. This difference was marginal for patients with 1.5-year life expectancy. Physician-hour involvement was less in SBRT group. The incremental cost adjusted effectiveness (Cost/QALY) for SBRT over RFA was $2,379 in the 5-year life expectancy cohort, and $2,216 for SBRT over RFA in the 1.5-year cohort. Sensitivity analysis demonstated robustness of these results across a range of utility values, costs, recurrence rates, and procedure-related morbidity. Conclusions: In comparison to RFA, SBRT was more cost-effective modality for unresectable or potentially resectable hepatic metastases over a wide range of treatment and disease assumptions, including recurrence rates, and procedure-related morbidity. Additionally, SBRT is a relatively fast outpatient procedure requiring less physician-hour involvement.

PWE-015 Radiofrequency ablation for management of malignant biliary obstruction

Introduction Malignant biliary obstruction is usually treated using metal stents at ERCP but some patients can develop stent dysfunction. Radiofrequency ablation (RFA) causes coagulative necrosis of tissue using thermal energy which may reduce tumour volume prior to biliary stenting or can be used to ablate ingrowth of tumour in previously placed stents. Improving stent patency has the potential to reduce morbidity, reduce reintervention rate and possibly improve survival. We report our experience in the use of RFA for malignant biliary obstruction. Method Retrospectively analysis of clinical and procedure related data of all patients undergoing RFA for malignant biliary obstruction over the last two years at Aberdeen Royal Infirmary. Age, sex and procedure/disease stage matched controls were selected from patients undergoing ERCP prior to the commencement of this service. Each RFA application delivers 10 watts of energy for 90 s via a specific probe passed through the lesion over a wire during ERCP. Technical success rates, complications, time to reintervention and date of death were recorded following the initial ERCP with RFA and Kaplan-Meier survival analysis performed. Results 12 patients underwent biliary 13 RFA applications during the study period (median age 78 years, 7 females). 5 patients had cholangiocarcinoma, 5 had pancreatic cancer, 1 had ampullary carcinoma and 1 had metastatic colorectal cancer. In 8 patients RFA was applied prior to biliary metallic stenting and good drainage was achieved. RFA was given in 1 – 3 applications with a median of 1 application. 4 patients underwent RFA for a blocked metal stent resulting in adequate biliary drainage in all cases. Post procedure complications included acute pancreatitis in 2 (mild) and Klebsiella bacteraemia and 30 day mortality rate was 0/12 (0%). 2 controls required reintervention within 30 days compared to none who received RFA. Median time to death or reintervention was 220 days in those receiving RFA compared o 131 in controls (Hazard ratio 0.59, 95% CI 0.25–1.4, p = 0.23). Conclusion Biliary RFA is a safe, useful adjunct in the management of malignant biliary obstruction or blocked metal stents. Time to death or reintervention was longer in those receiving RFA but a larger, prospective study is required to show a significant survival benefit. Disclosure of interest None Declared.

Application of cooled radiofrequency ablation in management of chronic joint pain

Radiofrequency ablation (RFA) is a minimally invasive neurotomy technique that can provide sensory ablation in patients with chronic pain. Cooled RFA, however, can create larger lesions compared with traditional RFA. Size of lesions plays a more important role in neurotomy of articular nerves where neural anatomy is not as predictable. We review the literature present about cooled radiofrequency neurotomy of articular branches of joints in patients with chronic pain of sacroiliac, hip, or knee joints. Sacroiliac joint pain is a significant etiology of low-back pain whereas low-back pain can be experienced by up to a third of the population. Chronic hip and knee pain can result in huge healthcare expenses as well as disability. The patients with chronic hip and knee pain might not be good candidates for arthroplasty surgeries because of their other comorbidities. Moreover, they might have persistent pain postoperatively. We also explain the technique used for neurotomy of articular branches in these joints.

Su1469 Efficacy of Radiofrequency Ablation in Management of Barrett's Esophagus: Real-Life Experience of Two Western Canadian Centers

Su1469 Efficacy of Radiofrequency Ablation in Management of Barrett's Esophagus: Real-Life Experience of Two Western Canadian Centers

Image-guided Percutaneous Splenic Interventions

In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.

Clinical study on safety of radiofrequency ablation for advanced pancreatic cancer

Objectives To evaluate the safety of radiofrequency ablation (RFA) for unresectable advanced pancreatic cancer. Methods During January 2002 to December 2007, seventy patients with advanced pancreatic cancer were treated by open cool-tip RFA. Clinical records of complications were retrospectively studied. Results Temporary fever occurred in all patients, and transient elevated blood amylase occurred in part of patients, and no celiac bleeding, no celiac abscess, no acute severe pancreatitis. The incidence of post-operation complications was 5.71% (4/70), and the mortality was 2.86 % (2/70). In the four cases, two were pancreatic leakage, one was upper gastrointestinal bleed-ing, and the other was vassular complication. Conclusions Radiofrequency ablation for advanced pan-creatic tumors is generally safe and feasible. However, it may cause severe and life-threatening compli-cations. The management of RFA must be prudent and careful. Key words: Pancreatic cancer; Radiofrequency ablation; Complication