Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non-Resectable Malignant Biliary Obstruction: A Single-Institution Experience
et al. (2015) Intraductal
Radiofrequency Ablation Followed by Locoregional
Tumor Treatments for Treating Occluded Biliary
Stents in Non-Resectable Malignant Biliary
Obstruction: A Single-Institution Experience. PLoS
ONE 10(8): e0134857. doi:10.1371/journal.
pone.0134857
Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non- Resectable Malignant Biliary Obstruction: A Single-Institution Experience
Xu-Hua Duan 0 1
Yan-Li Wang 0 1
Xin-Wei Han 0 1
Jian-Zhuang Ren 0 1
Teng-Fei Li 0 1
Jian-Hao Zhang 0 1
Kai Zhang 0 1
Peng-Fei Chen 0 1
0 Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University , No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province , People's Republic of China
1 Editor: Gianfranco Alpini, Texas A&M Health Science Center , UNITED STATES
-
Competing Interests: The authors have declared
that no competing interests exist.
tion and stent re-occlusion.
To determine the safety and feasibility of intraductal radiofrequency ablation (RFA) followed
by locoregional tumor treatments in patients with non-resectable malignant biliary
obstrucFourteen patients with malignant biliary obstruction and blocked metal stents were studied
retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were
monitored clinically and radiologically. The practicality, safety, postoperative complications,
jaundice remission, stent patency and survival time were analyzed.
Combination treatment was successful for all patients. There were no severe complications
during RFA or local treatments. All patients had stent patency restored, with a decline in
serum bilirubin. Three patients had recurrent jaundice by 195, 237 and 357 days; two
patients underwent repeat intraductal RFA; and one required an internal-external biliary
drain. The average stent patency time was 234 days (range 187-544 days). With a median
follow-up of 384 days (range 187-544 days), six patients were alive, while eight had died.
There was no mortality at 30 days. The 3, 6, 12 and 18 month survival rates were 100%,
100%, 64.3% and 42.9%, respectively.
Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe
and practically feasible and potential increase stent patency and survival times.
In patients suffering with unresectable malignant biliary obstruction with a life expectancy
longer than 3 months, stent placement by endoscopic retrograde cholangiopancreatography
(ERCP) or percutaneous transhepatic cholangiodrainage (PTCD) is the standard technique to
ensure continued biliary drainage [1, 2]. However, tumor ingrowth, epithelial cell hyperplasia,
clot accumulation and biliary sludge, amongst other complications, lead to a 50% stent
restenosis rate within 6 months of stent insertion [2]. Traditionally, insertion of internal-external
drains, balloon dilation, and stent replacement have been used to treat stent obstruction and
re-stenosis [3, 4]. With the technological development of radiofrequency ablation (RFA),
intraductal RFA catheters have played an increasingly important role in treating biliary stent
occlusion [2, 5]. Previous clinical studies have demonstrated the safety and efficacy of this novel
RFA catheter, which can be conducted endoscopically or by percutaneous transhepatic
cholangiography (PTC) [2, 5].
Intraductal RFA is a newly emerging technique that delivers heat energy directly to
neoplastic tissues to achieve tumor necrosis and to prolong biliary patency [2, 5, 6]. However, the heat
penetration depth in intraductal RFA is limited and cannot achieve radical tumor elimination.
In patients with malignant biliary obstruction, the median patency time of a metallic biliary
stent is 6–9 months [7]. Unfortunately, patients experience complications from recurrent
biliary obstruction due to local tumor progression, despite intraductal RFA and drainage. There
are a few reported cases of the application of percutaneous intraductal RFA for clearance of
occluded stents [8, 9], but tumor control after intraductal RFA in malignant biliary obstruction
was not reported. Transcatheter arterial chemoembolization (TACE) following PTCD and
stent implantation may significantly contribute to the survival time of patients with malignant
biliary obstruction, and may improve stent patency [10, 11].
We undertook a retrospective analysis of data from 14 patients to investigate the safety and
feasibility of intraductal RFA in biliary stent occlusion in patients with malignant biliary
obstruction. We extended our analysis to explore if locoregional tumor treatments including
TACE and intra-arterial chemotherapy with embolization of tumor-feeding arteries following
intraductal RFA could increase the survival time for these patients.
Materials and Methods
Ethics statement
The study was approved by the ethics committee of Biomedical Research of the First Affiliated
Hospital of Zhengzhou University and (...truncated)