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, Dec 2019

Objectives To determine the safety and feasibility of intraductal radiofrequency ablation (RFA) followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion. Methods Fourteen 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. Results 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. Conclusion Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

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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)


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Xu-Hua Duan, Yan-Li Wang, Xin-Wei Han, Jian-Zhuang Ren, Teng-Fei Li, Jian-Hao Zhang, Kai Zhang, Peng-Fei Chen. 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, 2015, 8, DOI: 10.1371/journal.pone.0134857