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Dig Dis Sci. 2015 Nov;60(11):3449-55. doi: 10.1007/s10620-015-3731-8. Epub 2015 Jun 3.

Analysis of Endoscopic Radiofrequency Ablation of Biliary Malignant Strictures in Pancreatic Cancer Suggests Potential Survival Benefit.

Author information

1
HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. yiannis.kallis@nhs.net.
2
HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. natalie.phillips@imperial.nhs.uk.
3
Department of Gastroenterology, Chelsea and Westminster Hospital NHS Trust, London, UK. alan.steel@chelwest.nhs.uk.
4
HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. harry.kaltsidis@nhs.net.
5
HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. panagiotis.vlavianos@imperial.nhs.uk.
6
Academic Department of Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. nagy.habib@imperial.nhs.uk.
7
HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. david.westaby@imperial.nhs.uk.

Abstract

BACKGROUND:

Pancreatic carcinoma is often inoperable, carries a poor prognosis, and is commonly complicated by malignant biliary obstruction. Phase I/II studies have demonstrated good safety and early stent patency using endoscopic biliary radiofrequency ablation (RFA) as an adjunct to self-expanding metal stent (SEMS) insertion for biliary decompression.

AIM:

To analyze the clinical efficacy of endobiliary RFA.

METHODS:

Retrospective case-control analysis was carried out for 23 patients with surgically unresectable pancreatic carcinoma and malignant biliary obstruction undergoing endoscopic RFA and SEMS insertion and 46 controls (SEMS insertion alone) in a single tertiary care center. Controls were stringently matched for age, sex, metastases, ASA/comorbidities. Survival, morbidity, and stent patency rates were assessed.

RESULTS:

RFA and control groups were closely matched-ASA 2.35 ± 0.65 versus 2.54 ± 0.50, p = 0.086; metastases 9/23 (39.1%) versus 18/46 (39.1%), p = 0.800; chemotherapy 16/23 (69.6%) versus 24/46 (52.2%), p = 0.203. Median survival in RFA group was 226 days (IQR 140-526 days) versus 123.5 days (IQR 44-328 days) in controls (p = 0.010). RFA was independently predictive of survival at 90 days (OR 21.07, 95% CI 1.45-306.64, p = 0.026) and 180 days (OR 4.48, 95% CI 1.04-19.30, p = 0.044) in multivariate analysis. SEMS patency rates were equivalent in both groups. RFA was well tolerated with minimal side effects.

CONCLUSIONS:

Endoscopic RFA is a safe and efficacious adjunctive treatment in patients with advanced pancreatic malignancy and biliary obstruction and may confer early survival benefit. Randomized prospective clinical trials of this new modality are mandated.

KEYWORDS:

Biliary metal stent; Malignant biliary stricture; Obstructive jaundice; Therapeutic endoscopy

PMID:
26038094
DOI:
10.1007/s10620-015-3731-8
[Indexed for MEDLINE]
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