Endoluminal radiofrequency ablation with stenting versus stenting alone in patients with malignant biliary obstruction: a meta-analysis of randomized trials

Daryl Ramai; Marcello Maida; Eric R. Smith; Yichen Wang; Marco Spadaccini; Melissa Previtera; Saurabh Chandan; Yuting Huang; Salih Tokmak; Peter Bhandari; Jason DuBroff; Christopher Ko; John D. Morris; Giovanni Marasco; Stefano Francesco Crinó; Antonio Facciorusso; Benedetto Mangiavillano; Mouen A Khashab

doi:10.1055/a-2378-9533

Endoscopy, Table of Contents

Endoscopy 2025; 57(03): 272-281
DOI: 10.1055/a-2378-9533

Systematic review

Endoluminal radiofrequency ablation with stenting versus stenting alone in patients with malignant biliary obstruction: a meta-analysis of randomized trials

Daryl Ramai

¹Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)

,

Marcello Maida

²Gastroenterology, S. Elia - Raimondi Hospital, Caltanissetta, Italy

³Medicine and Surgery, Kore University of Enna, Enna, Italy (Ringgold ID: RIN217140)

,

Eric R. Smith

⁴Medicine, Baylor Scott & White Health, Dallas, United States (Ringgold ID: RIN423342)

,

Yichen Wang

⁵Hospital Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States (Ringgold ID: RIN14640)

,

Marco Spadaccini

⁶Endoscopy Unit, Istituto Clinico Humanitas, Rozzano, Italy (Ringgold ID: RIN9268)

⁷Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)

,

Melissa Previtera

⁸Donald C. Harrison Health Sciences Library, University of Cincinnati Libraries, Cincinnati, United States (Ringgold ID: RIN491495)

,

Saurabh Chandan

⁹Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, United States (Ringgold ID: RIN25095)

,

Yuting Huang

¹⁰Gastroenterology and Hepatology, Mayo Clinic in Florida, Jacksonville, United States (Ringgold ID: RIN156400)

,

Salih Tokmak

¹¹Gastroenterology, Duzce University, Duzce, Turkey (Ringgold ID: RIN121595)

,

Peter Bhandari

¹²Medicine, Lenox Hill Hospital, New York, United States (Ringgold ID: RIN5945)

,

Jason DuBroff

¹Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)

,

Christopher Ko

¹Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)

,

John D. Morris

¹Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)

,

Giovanni Marasco

¹³Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)

¹⁴Medicine, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

,

Stefano Francesco Crinó

¹⁵Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, University of Verona, Verona, Italy (Ringgold ID: RIN19051)

,

Antonio Facciorusso

¹⁶Medical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy (Ringgold ID: RIN18972)

,

Benedetto Mangiavillano

¹⁷Gastrointestinal Endoscopy, Istituto Clinico Mater Domini Casa di Cura Privata SpA, Castellanza, Italy (Ringgold ID: RIN9348)

,

Mouen A Khashab

¹⁸Therapeutic Endoscopy, Division of Gastroenterology, Johns Hopkins Medical Institutions Campus, Baltimore, United States (Ringgold ID: RIN1501)

› Author Affiliations

Abstract

Background: Endoluminal radiofrequency ablation (RFA) is a palliative treatment for patients suffering from malignant biliary obstruction (MBO). We aimed to conduct a meta-analysis to evaluate the impact of RFA on stent patency, patient survival, and adverse events.

Methods: Major databases were searched through December 2023 for patients who had undergone stenting with or without RFA for extrahepatic MBO. A random-effects model was used for analysis, with results expressed as relative risk ratios (RRs) with 95%CIs.

Results: Nine RCTs involving 750 subjects with MBO (374 RFA plus stent vs. 376 stent only) were included. Meta-analysis revealed similar risks of stent patency at 3 months (RR 1.01, 95%CI 0.92–1.11; I ² = 4%) for RFA plus stenting vs. stent only. Meta-analysis showed improved survival at 6 months (RR 0.84, 95%CI 0.73–0.96; I ² = 21%; P = 0.01) for RFA plus stenting vs. stent only. Subgroup analysis comparing plastic vs. uncovered metal stents showed that stent patency was unaffected at 3 months (RR 1.06, 95%CI 0.91–1.23; I ² = 17%). Subgroup analysis showed that patients with cholangiocarcinoma experienced an overall survival benefit with RFA plus stenting vs. stenting alone (P < 0.001); however, stent patency remained unaffected (P = 0.08). An increased incidence of cholecystitis was noted with RFA plus stenting vs. stenting alone (5.1% [95%CI 3.1%–7.8%] vs. 0.3% [95%CI 0.01%–1.5%], respectively).

Conclusion: Combining endoluminal RFA and stenting may improve overall survival in patients with MBO. RFA did not significantly impact stent patency.

Full Text

References

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Supplementary Material

Supplementary Material