Korean J Med.  2022 Jun;97(3):164-170. 10.3904/kjm.2022.97.3.164.

Intraductal Radiofrequency Ablation as a Palliative Treatment for Advanced Malignant Hilar Biliary Obstruction

• Kang H
• Kim EJ
• Kim YS

• KMID: 2530578
• DOI: http://doi.org/10.3904/kjm.2022.97.3.164

Abstract

Malignant hilar biliary obstruction (MHBO) frequently accompanies cholestasis and cholangitis, and requires biliary stent placement. To prevent stent occlusion and prolong survival, local ablation therapy can be considered adjunctive to stent placement. Intraductal radiofrequency ablation (ID-RFA) is a recently developed local therapy for malignant biliary obstruction that can be easily performed employing endoscopic retrograde cholangiography. The use of ID-RFA to treat MHBO (as distinct from distal biliary obstruction) was suggested to be associated with severe adverse events. However, recent comparative studies have shown that ID-RFA is feasible and safe, and acceptably efficacious, in patients with advanced MHBO; newer temperature-controlled ID-RFA devices may enhance safety further. Regularly repeated ID-RFA with stent exchange affords better survival than stenting alone. However, the optimal ID-RFA strategy for MHBO remains inconclusive given the lack of data. Further large-scale clinical trials are needed.

Keyword

고주파 소작술; 내시경적역행성담췌관조영술; 담관암; 담관 폐쇄; 황달; Radiofrequency ablation; Cholangiopancreatography, endoscopic retrograde; Cholangiocarcinoma; Biliary tract neoplasms; Cholestasis