Advertisement

Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis

Published:November 03, 2017DOI:https://doi.org/10.1016/j.gie.2017.10.029

      Background and Aims

      Unresectable malignant biliary strictures are generally managed by palliative stent placement for drainage of biliary tree. Recently, radiofrequency ablation (RFA) has been used to improve the patency of biliary stents in these patients. Several studies have evaluated the effectiveness of biliary stent placement with RFA on stent patency and patient survival with variable results. We performed this meta-analysis to evaluate the efficacy and safety of biliary stent placement with RFA compared with stent placement alone in patients with malignant biliary strictures.

      Methods

      We performed a comprehensive search of electronic databases for all studies comparing RFA with biliary stent placement versus stent placement only. Measured outcomes included patient survival, stent patency, and procedure-related adverse events. An inverse variance method was used to pool data on stent patency into a random-effects model. Cox-regression analysis was used to calculate hazard ratio for survival analysis. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to interpret our findings.

      Results

      Nine studies (including 2 abstracts) with a total of 505 patients were included in the meta-analysis. The pooled weighted mean difference in stent patency was 50.6 days (95% confidence interval [CI], 32.83-68.48), favoring patients receiving RFA. Pooled survival analysis of the reconstructed Kaplan-Meier data showed improved survival in patients treated with RFA (hazard ratio, 1.395; 95% CI, 1.145-1.7; P < .001). However, RFA was associated with a higher risk of postprocedural abdominal pain (31% vs 20%, P = .003). Our analysis did not show significant difference between the RFA and stent placement–only groups with regard to the risk of cholangitis, acute cholecystitis, pancreatitis, and hemobilia.

      Conclusions

      In the light of this limited data based on observational studies, RFA was found to be safe and was associated with improved stent patency in patients with malignant biliary strictures. In addition, RFA may be associated with improved survival in these patients.

      Abbreviations:

      CI (confidence interval), RFA (radiofrequency ablation), SEMS (self-expanding metal stents)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smith A.C.
        • Dowsett J.F.
        • Russell R.C.
        • et al.
        Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction.
        Lancet. 1994; 344: 1655-1660
        • O'Brien S.
        • Hatfield A.R.
        • Craig P.I.
        • et al.
        A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction.
        Gut. 1995; 36: 618-621
        • Loew B.J.
        • Howell D.A.
        • Sanders M.K.
        • et al.
        Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial.
        Gastrointest Endosc. 2009; 70: 445-453
        • Ortner M.E.
        • Caca K.
        • Berr F.
        • et al.
        Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study.
        Gastroenterology. 2003; 125: 1355-1363
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann Intern Med. 2009; 151: 264-269
        • Kallis Y.
        • Phillips N.
        • Steel A.
        • et al.
        Analysis of endoscopic radiofrequency ablation of biliary malignant strictures in pancreatic cancer suggests potential survival benefit.
        Dig Dis Sci. 2015; 60: 3449-3455
        • Guyot P.
        • Ades A.E.
        • Ouwens M.J.
        • et al.
        Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves.
        BMC Med Res Method. 2012; 12: 9
        • Hu B.G.D.
        • Zhang X.
        • Zhang Y.
        Endoscopic RFA improves overall survival of cholangiocarcinoma: a multicenter randomized control study.
        Gastrointest Endosc. 2016; 83 ([abstract]): AB126
        • Wang J.
        • Zhao L.
        • Zhou C.
        • et al.
        Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for nonresectable malignant biliary obstruction improves stent patency but not survival.
        Medicine (Baltimore). 2016; 95: e3329
        • Wu T.T.
        • Li W.M.
        • Li H.C.
        • et al.
        Percutaneous intraductal radiofrequency ablation for extrahepatic distal cholangiocarcinoma: a method for prolonging stent patency and achieving better functional status and quality of life.
        Cardiovasc Intervent Radiol. 2017; 40: 260-269
        • Li T.F.
        • Huang G.H.
        • Li Z.
        • et al.
        Percutaneous transhepatic cholangiography and intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction.
        J Vasc Interv Radiol. 2015; 26: 715-721
        • Sampath K.H.S.
        • Gardner T.
        • Gordon S.R.
        The effect of endoscopic radiofrequency ablation on survival in patients with unresectable peri-hilar cholangiocarcinoma [abstract].
        Gastrointest Endosc. 2016; 83: AB595
        • Cui W.W.Y.
        • Fan W.
        • Lu M.
        • et al.
        Comparison of intraluminal radiofrequency ablation and stents versus stents alone in the management of malignant biliary obstruction.
        Int J Hypertherm. 2017; 33: 853-861
        • Liang H.P.Z.
        • Cao L.
        • Qian S.
        • et al.
        Metal stenting with or without endobiliary radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma.
        J Cancer Ther. 2015; 6: 981-992
        • Kadayifci A.
        • Atar M.
        • Forcione D.G.
        • et al.
        Radiofrequency ablation for the management of occluded biliary metal stents.
        Endoscopy. 2016; 48: 1096-1101
        • Hansler J.
        • Wissniowski T.T.
        • Schuppan D.
        • et al.
        Activation and dramatically increased cytolytic activity of tumor specific T lymphocytes after radio-frequency ablation in patients with hepatocellular carcinoma and colorectal liver metastases.
        World J Gastroenterol. 2006; 12: 3716-3721
        • den Brok M.H.
        • Sutmuller R.P.
        • van der Voort R.
        • et al.
        In situ tumor ablation creates an antigen source for the generation of antitumor immunity.
        Cancer Res. 2004; 64: 4024-4029