Endobiliary radiofrequency ablation in pCCA: a pilot study

A pilot study demonstrated the safety and feasibility of endobiliary radiofrequency ablation (eRFA) in advance of uncovered self-expanding metal stent (uSEMS) placement in patients with perihilar cholangiocarcinoma (pCCA). Randomised-controlled trials are now needed to assess the efficacy of this intervention.

Biliary drainage is standard-of-care in the palliative treatment of patients with pCCA. Although uSEMS is preferred over plastic stents, due to the longer stent patency and fewer re-interventions, there is a risk of recurrent biliary obstruction by tumour ingrowth. As such, eRFA may be a helpful additional therapy to reduce tumour ingrowth and improve stent patency. Dr Jeska Fritzsche (Amsterdam UMC, the Netherlands) and colleagues investigated the safety and feasibility of eRFA prior to uSEMS placement in patients with pCCA [1]. Between April 2021 and March 2022, a single-centre pilot study included 10 participants with a median age of 68.5 years, a median stricture length of 30 mm, and a median serum total bilirubin of 15 μmol/L. The outcome measures were technical success, clinical success, adverse events, stent patency, and re-interventions.

According to the authors, the procedure was technically and clinically successful in all treated participants. One of the participants had a self-limiting bleeding event of grade 2, and 7 participants experienced post-procedural abdominal discomfort. After 14 months of follow-up, the stent patency was 78%, with an estimated median stent patency of 8 months. Also, the re-intervention rate was 67%, with an estimated 2.0 re-interventions per patient-year. In addition, recurrent biliary obstruction occurred in 7 participants, with 6 cases of ingrowth and 1 case of sludge.

This pilot study showed that eRFA prior to uSEMS placement may be a safe and feasible treatment option in patients with pCCA. According to Dr Fritzsche, the risk of post-procedural pain is no reason to be reluctant to use eRFA in this population. The next step is to conduct randomised-controlled trials to assess the efficacy of the intervention.

1. 
   
   1. Fritzsche JA, et al. Endobiliary radiofrequency ablation for malignant biliary obstruction due to perihilar cholangiocarcinoma (RACCOON-P): a prospective pilot study. MP234, UEG Week 2023, 14–17 October, Copenhagen, Denmark.

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Posted on 7 December 202330 April 2024