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World J Gastrointest Endosc. Feb 16, 2019; 11(2): 95-102
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.95
Radiofrequency and malignant biliary strictures: An update
Francesco Auriemma, Luca De Luca, Mario Bianchetti, Alessandro Repici, Benedetto Mangiavillano
Francesco Auriemma, Mario Bianchetti, Benedetto Mangiavillano, Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Via Gerenzano 2, Castellanza 21053, Italy
Luca De Luca, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Via Cesare Lombroso 1, Pesaro 61122, Italy
Alessandro Repici, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano 20089, Italy
Alessandro Repici, Benedetto Mangiavillano, Humanitas Huniversity, Hunimed, Via Rita Levi Montalcini, 4, Pieve Emanuele 20090, Italy
Author contributions: Auriemma F and Mangiavillano B designed research, made sources analysis, wrote the paper; De Luca L, Bianchetti M and Repici A contributed to critically review and accepted the final draft.
Conflict-of-interest statement: No conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Benedetto Mangiavillano, MD, Chief Doctor, Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Via Gerenzano 2, Castellanza 21053, Italy. benedetto.mangiavillano@materdomini.it
Telephone: +39-33-1476381 Fax: +39-33-1476205
Received: December 6, 2018
Peer-review started: December 6, 2018
First decision: December 20, 2018
Revised: January 25, 2019
Accepted: February 13, 2019
Article in press: February 13, 2019
Published online: February 16, 2019
Abstract

Malignant biliary strictures are usually linked to different types of tumors, mainly cholangiocarcinoma, pancreatic and hepatocellular carcinomas. Palliative measures are usually adopted in patients with nonresectable or borderline resectable biliary disease. Stent placement is a well-known and established treatment in patients with unresectable malignancy. Intraductal radiofrequency ablation (RFA) represents a procedure that involves the use of a biliary catheter device, via an endoscopic approach. Indications for biliary RFA described in literature are: Palliative treatment of malignant biliary strictures, avoiding stent occlusion, ablating ingrowth of blocked metal stents, prolonging stent patency, ablating residual adenomatous tissue after endoscopic ampullectomy. In this mini-review we addressed focus on technical success defined as deployment of the RF catheter, virtually succeeded in all patients included in the studies. About efficacy, three main outcome measures have been contemplated: Biliary decompression and stent patency, survival. Existing studies suggest a beneficial effect on survival and stent patency with RFA, but current impression is limited because most of studies have been performed using a retrospective design, on diminutive and dissimilar cohorts of patients.

Keywords: Radiofrequency, Ablation, Endoscopic retrograde colangiopancreatography, Malignant biliary strictures

Core tip: Intraductal radiofrequency ablation (RFA) represents a procedure that encompasses the use of a biliary catheter device, via an endoscopic approach, mainly endoscopic retrograde colangiopancreatography. Indications for biliary RFA described in literature are: Palliative treatment of malignant biliary strictures, avoiding stent occlusion, ablating ingrowth of blocked metal stents, prolonging stent patency, ablating residual adenomatous tissue after endoscopic ampullectomy. Existing studies suggest a favorable effect on survival and stent patency. Moreover, up-to-date feeling is that evidence supporting RFA is limited because most of the analyses have been achieved using a retrospective design, on diminutive and dissimilar cohorts of patients.