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.