Endobiliary Radiofrequency Ablation in Malignant Biliary Strictures: Nonrandomized Prospective Cohort Study

Objective: Self-expandable metallic stents are superior to establish and preserve biliary drainage in malignant biliary obstructions. Endobiliary radiofrequency ablation (EB-RFA) is an important adjunct to increase the efficacy and length of the stent patency. This study is on the efficacy and safety of transhepatic EB-RFA and discusses its procedural steps and technical tips for successful implementation. Material and Methods: Clinical and imaging data of eight patients were retrospectively analyzed. The intervention included EBRFA, stenting, balloon dilatation and temporary internal biliary catheterization of previously untreated cases. The technical efficacy was determined as the percentage of successfully catheterized patients. The short-term clinical efficacy was determined as the comparison of pre- and post-procedural total and direct bilirubin levels. Results: The mean pre-ablation luminal diameter was 2.4±0.7 mm and the mean post-ablation luminal diameter 7.8±2.0 mm. No intraprocedural and 30-day mortality was encountered. Multiple hepatic abscesses developed in a patient who had re-ablation and two others experienced cholangitis. The most common minor complication was abdominal pain. The preprocedural total bilirubin level was 8.39±3.45 and the direct bilirubin level was 6.82±3.11. The postprocedural total bilirubin level at 7th day was 4.10±2.85 and direct bilirubin level was 2.96±2.16. Patients were followed up to 6.5 months after the procedure. The mean patency time was 56 days and the mean survival was 122 days. Conclusion: This study supports previous reports on EB-RFA and shows the safety and the efficacy of the technique and its implementation. Keeping all procedural steps and possible complications in mind, it has a relatively short learning curve.