ENDOSCOPIC RADIOFREQUENCY ABLATION FOR EXTRAHEPATIC MALIGNANT BILIARY OBSTRUCTION: SAFETY AND EFFICACY OF A SINGLE CENTER ESPERIENCE

Aims:

Malignant biliary obstruction is often secondary to pancreatic cancer or cholangiocarcinoma. Most of patients present at advanced stage with a short life expectancy and no chance of resolutive therapy. patients with ingravescent icterus, endoscopic drainage is performed with position of metal or plastic biliary stents. Radiofrequency ablation (RFA) have already been studied to improve stent patency and to treat liver lesions percutaneous via. The aim of our study is to assess efficacy and safety of RFA ablation in patients unfit for surgery with malignant biliary obstruction due to extrahepatic colangiocarcinoma.

Methods:

We enrolled 6 pts (mean age 71 years, 5 male) from October 2014 to June 2016 affected with extrahepatic colangiocarcinoma with or without ongoing chemiotherapy and unfit for surgery. All the patients underwent biliary sphincterotomy and a colangiogramm to confirm stricture location, length and diameter. The Habib Endo HPB probe was advanced over a wire and the stricture was ablated using an ERBE generator. A fully covered/plastic stent was placed after each RFA session to prevent stenosis.

Results:

The mean treated stricture length was 22,5 mm with a mean number of procedures of 3. Technical success was achieved in 100% with preferably metal fully covered stent placement in each patients after the ablation. No early adverse event was recorded: one colecistitis after 30 days in one patient after the third ablation, managed with medical therapy. Moreover the overall survival curve was compared with the SEER database registry stratified by diagnosis and stage demonstrated a significantly improved survival in patients who have received RFA.

Conclusions:

Even if in a retrospective manner, with a small number of patients and in absence of a comparison population, our study suggests that RFA may offer a safe, effective alternative therapy to patients with malignant biliary extra hepatic obstruction possibly, unfit for surgery, conferring a suvival benefit.