Safety And Efficacy Of Radiofrequency Ablation In The Palliative Management Of Malignant Biliary Strictures

INTRODUCTION: The clinical efficacy of intraductal Radiofrequency ablation (RFA) with Habib™ EndoHPB catheter, a newly developed intervention for prolonging stent patency is evolving. RFA with Habib™ EndoHPB Catheter has been studied retrospectively in patients with extrahepatic distal Cholangiocarcinoma and has been shown to prolong stent patency and improve quality of life. Endoscopic transhepatic intraductal RFA with a HabibTM EndoHPB catheter followed by placement of covered or uncovered biliary self-expandable metallic stents (SEMs) appears to be a superior approach to SEMs alone. In our center, in the past two years, we have placed palliative stents with HabibTM for patients with metastatic cancer and extrahepatic biliary obstruction. Our goal is to assess the safety and efficacy of HabibTM in the management of malignant biliary strictures. METHODS: We retrospectively reviewed data of 8 patients who had undergone endoscopic transhepatic intraductal RFA with HabibTM EndoHPB followed by placement of SEMs. Data collected include patient demographics, indication for palliative stenting, pre-and post-serum bilirubin concentrations, duration of the stent before repeat intervention/death, procedure-related complications such as bleeding and stent displacement. RESULTS: Our patient sample comprised 4 females and 4 males with an age range of 54 to 92 years. HabibTM intervention was carried out within 3 to 7 months after diagnosis. See Chart 1 below for patients' diagnoses pre- HabibTM intervention. Of the 8 patients, 3 had full or partly covered SEMs, 2 had uncovered SEMs, 3 had plastic stents. There was no evidence of bleeding or stent displacement. Two mortalities were observed between 1- and 10-months post-Habib intervention. For 6 of the patients with follow-up data, average stent duration was 2.5 months before repeat intervention or death. The average total bilirubin pre-intervention was 6.5 mg/dl compared to a post-intervention average total bilirubin of 3.8 mg/dl; a reduction of just under 42%. Although this appears to be a modest change, as more data become available, it would be of interest to determine if this change is significant. CONCLUSION: Prolongation of stent patency is an important endpoint in the palliative management of patients with extrahepatic malignancy. A multicenter randomized controlled trial is required to confirm the long-term benefits of RFA and stenting compared to stenting alone.Table 1