J Korean Soc Radiol.  2017 Nov;77(5):298-308. 10.3348/jksr.2017.77.5.298.

Safety and Efficacy of Percutaneous Intraductal Radiofrequency Ablation Followed by Dual Stent Placement for Malignant Biliary Hilar Obstruction

• Jeon CH
• Kim CW
• Kwon H

• KMID: 2394043
• DOI: http://doi.org/10.3348/jksr.2017.77.5.298

Abstract

PURPOSE
To evaluate the safety and clinical efficacy of percutaneous intraductal radiofrequency ablation (RFA) followed by dual stent placement in advanced malignant biliary hilar duct obstruction.
MATERIALS AND METHODS
Between September 2013 and August 2015, ten patients with malignant biliary hilar duct obstruction who underwent percutaneous intraductal RFA followed by dual stent placement were included in this retrospective study. Technical success, clinical success, procedure-related complications, stent patency, and patient's survival durations after treatment were investigated.
RESULTS
Percutaneous intraductal RFA followed by dual stent placement was successful in all patients; the technical success rate was 100%. No major complications were identified. After the procedure, serum total bilirubin levels were notably normalized, and therefore, percutaneous transhepatic biliary drainage (PTBD) catheter was successfully removed in 8 patients; the clinical success rate was 80%. Four patients with stent dysfunction associated with tumor ingrowth/overgrowth underwent a repeat PTBD procedure or secondary stent insertion. Mean stent patency and survival durations were 233.8 ± 35.6 days [95% confidence interval (CI), 164.0-303.5 days] and 387.2 ± 114.6 days (95% CI, 162.6-611.8 days), respectively.
CONCLUSION
Percutaneous intraductal RFA combined with dual stent placement in advanced malignant biliary hilar duct obstruction is a safe and feasible palliative treatment option.

MeSH Terms

Ablation Techniques
Bile Duct Neoplasms
Bilirubin
Catheter Ablation*
Catheters
Cholestasis
Drainage
Humans
Palliative Care
Retrospective Studies
Self Expandable Metallic Stents
Stents*
Treatment Outcome
Bilirubin

Figure

• 

  Fig. 1 The ELRA™ is a bipolar radiofrequency catheter with four radiologically marked electrodes (between the arrowheads) at the tip and temperature sensor inside.

• 

  Fig. 2 62-year-old man with Bismuth type IV hilar cholangiocarcinoma confirmed by diagnostic biopsy. A. A catheter-directed percutaneous transhepatic cholangiography demonstrates the stricture (arrows). B-D. Radiofrequency ablation for proximal CBD (arrows), LMD (white arrows), and RMD (arrowheads), respectively. E. A transverse stent deployment to cover stenosis at LMD-RMD (arrows). F. A vertical stent deployment at LMD-CBD in a stent-in-stent manner as T-configuration dual stents placement (arrows). G. Choledochoscopy shows maintenance of ductal luminal patency by ablation of intraductal tumor followed by metallic stent deployment. CBD = common bile duct, LMD = left main duct, RMD = right main duct

• 

  Fig. 3 73-year-old woman with Bismuth type IV hilar cholangiocarcinoma underwent fluoroscopy-guided biliary drainage catheter placement bilaterally. A. A catheter-directed percutaneous transhepatic cholangiography demonstrates the stricture (arrows). B. Radiofrequency ablation (arrows) for RMD-proximal CBD. Ablation for LMD was done, additionally (not shown). C. Post-ablation cholangiography shows residual partial hilar stenosis (arrows). D. Y-configuration dual stents placement to cover stenoses at RMD-CBD (arrows), LMD-CBD (white arrows) in a stent-by-stent manner. CBD = common bile duct, LMD = left main duct, RMD = right main duct

• 

  Fig. 4 Stent patency and patient survival duration. A. Kaplan-Meier curve of stent patency. The calculation starts on the day of PTBD catheter removal after percutaneous intraductal RFA followed by stent deployment procedure and extends to the time of proven stent dysfunction. B. Kaplan-Meier curve of patient survival duration. The calculation starts on the date of day of PTBD catheter removal after percutaneous intraductal RFA followed by stent deployment procedure and extends to the date of death. PTBD = percutaneous transhepatic biliary drainage, RFA = radiofrequency ablation

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