Asad Malik, MD
Clinical Research Fellow
Disclosure(s): No financial relationships to disclose
Biliary obstruction caused by benign/malignant strictures and in-stent stenosis can impair the quality of life and lead to complications if left untreated. This retrospective study aims to discuss the technique, efficacy and complications of percutaneous endobiliary radiofrequency ablation (RFA) performed by interventional radiology (IR) for biliary obstruction.
Materials and Methods:
Twenty-one RFA procedures were performed on 20 consecutive patients (11 males, mean age: 58 years [range: 31-82]). Eleven (55%) patients had malignant biliary obstructions and 9 (45%) had benign obstructions; out of these, 5/20 (25%) had in-stent stenoses. Paired samples Wilcoxon test was used to compare the total number of IR procedures performed pre- versus post-RFA.
The average fluoroscopy time was 21.5 minutes (range: 0.5-80.6 minutes) and the average procedure time was 2 hours (range: 0.8-4 hours). Intraluminal ultrasound probe was used in 5 (25%) procedures and cholangioscopy was performed before and after endobiliary RFA in 21 (100%) procedures. The median number of RFA stations per procedure was 2 (range: 1-3). Technical success was achieved in 20 (95%) procedures, with improved patency and luminal flow observed on post-RFA cholangiography. The drain was replaced in 11 (52%) procedures, cholangioplasty was performed in 16 (76%) and stenting was performed in 18 (86%) procedures. In 15 (71%) procedures, the operator was able to successfully remove the drain after ablation, with a mean post-RFA drain duration of 0.5 months (range: 1-3 months). Whereas before RFA, the mean drain duration was 11.8 months (range: 1-74 months). The median number of IR procedures pre- versus post-RFA were 5 and 1, respectively (P=0.0001). Major complication (septic shock) was seen with 1 (5%) procedure and minor complications (e.g., pain, catheter leak, biloma, etc.) were seen with 3 (14%) procedures.
Percutaneous endobiliary radiofrequency ablation can be successfully used to relieve obstruction in patients with both benign and malignant strictures. This minimally invasive technique can help patients become drain-free and decrease the total number of IR procedures required to manage the obstruction.