Radiofrequency ablation for management of malignant biliary obstruction: a single-center experience and review of the literature.
BACKGROUND
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.
['Dutta|Amit Kumar|AK|', 'Basavaraju|Umesh|U|', 'Sales|Laura|L|', 'Leeds|John Samuel|JS|']
D000368:Aged D017115:Catheter Ablation D002779:Cholestasis D018572:Disease-Free Survival D005240:Feasibility Studies D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D015999:Multivariate Analysis D009369:Neoplasms D016016:Proportional Hazards Models D012189:Retrospective Studies D012307:Risk Factors D015607:Stents D013997:Time Factors D016896:Treatment Outcome
Radiofrequency ablation cholangiocarcinoma adverse events survival pancreatic carcinoma