Post written by Yubeen Park, MS, Jung-Hoon Park, PhD, and Sang Soo Lee, MD, PhD, from Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Endobiliary radiofrequency ablation (RFA) was introduced as a promising therapeutic option for unresectable malignant biliary obstruction. However, insufficient contact between the traditional catheter-type electrode and bile duct wall because of irregular tumor growths or nontight strictures can cause incomplete ablation.

Sometimes, unexpected excessive heating of the curved bile duct occurs. We developed novel self-expandable stent–based endobiliary RFA (SES-RFA) with a polarity-switching, generating system to solve unmet clinical needs. This study aimed to evaluate the efficacy of the SES-RFA system with a customized RFA generator in the porcine liver and common bile duct.

Malignant biliary obstruction is a severe adverse effect associated with cholangiocarcinoma and other cancers. Traditional treatment options are limited, especially for patients ineligible for surgery. Development of a novel SES-RFA system is important for exploring new approaches that may provide improved clinical outcomes. This study was essential to evaluate the efficacy and safety of this system in a porcine model and to provide ablation ranges according to various radiofrequency parameters and guidelines for future clinical practices.

The study successfully demonstrated the efficacy and safety of the novel SES-RFA system, which achieved even and deep circumferential ablation without ductal perforation. A polarity-switching system was integrated for promoting creation of a more consistent ablation area between the 2 stent-type electrodes. Although adjusting radiofrequency power and time could control ablation depth and length, uniformity of ablation with SES-RFA represents a significant advancement.

Before clinical trials, long-term animal studies should be conducted to ensure the system’s continued efficacy and safety. Furthermore, comparisons with other endobiliary RFA systems will be required to fully validate the SES-RFA system’s benefits.

The system could be a significant step forward in the treatment of unresectable malignant biliary obstruction, potentially setting a new standard of care for patients with few other options. Continued research and development are required to optimize and integrate this technology into clinical practice.

Graphical abstract

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