Endoscopic radiofrequency ablation plus plastic stent placement versus stent placement alone for unresectable extrahepatic biliary cancer

Post written by Bing Hu, MD, PhD, from the Department of Gastroenterology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Yangpu District, and the Department of Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Jiading District, Shanghai, China.

The focus of our study is to compare the efficacy and safety between endoscopic radiofrequency ablation (RFA) and stent placement alone in patients with unresectable extrahepatic biliary cancer (EBC) and provide high-quality evidence of palliative therapy of EBC.

Early diagnosis of EBC is difficult, and radical surgery is usually impossible when diagnosed. Biliary stent placement is the primary palliative treatment for inoperable EBC. Although it can reduce jaundice and improve patients’ quality of life, it cannot prolong survival time. The efficacy of radiotherapy and chemotherapy on EBC is not significant, and the acceptance of radiotherapy and chemotherapy is shallow, especially in China and some Asian regions. And the median survival of most patients is less than 6 months. Therefore, the prognosis of a patient with inoperable EBC is very bleak, which urges us to explore radiofrequency ablation in the bile duct to improve the patient’s survival time and quality of life.

Two sessions of endobiliary RFA with a 3-month interval, in addition to stent placement, can improve the median overall survival from 9.2 to 14.3 months and quality of life in patients with inoperable EBC with acceptable safety, who do not undergo systemic treatments. Increased overall survival was also noted in all the subgroups of hilar cholangiocarcinoma, distal cholangiocarcinoma, and ampullary cancer. However, the RFA group experienced significantly more postprocedural cholecystitis. Further prospective studies are needed to determine the optimal therapeutic strategy, such as the repeated ablation times, the interval, combining with systemic treatments, for this patient population.

Hu

Figure 3. Kaplan-Meier analyses of overall survival (OS) and plastic stent patency between the 2 groups. A, OS in both groups. B, OS in the patients with cholangiocarcinoma. C, Stent patency between the 2 groups. RFA, Radiofrequency ablation; HR, hazard ratio; CI, confidence interval.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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