Background.
Radiofrequency ablation (RFA) is a palliative method known for its application in the endoscopic treatment of malignant
bile duct obstruction. It may be a useful rescue method for
metal stent malfunction caused by
tumor ingrowth. This study aimed to examine the feasibility and safety of endoluminal RFA for occluded bilateral hilar
metal stents due to
tumor ingrowth in patients with malignant hilar
bile duct obstruction. Methods: From March 2016 to June 2018, 11 patients with unresectable malignant hilar bile duct
stricture with occluded bilateral hilar
metal stents due to
tumor ingrowth were enrolled. Endoluminal RFA was performed through a novel temperature-controlled
catheter at a setting of 7 W power for 120 s with a target temperature of 80 °C via endoscopic retrograde cholangiopancreatography (ERCP). The patients' demographics, clinical outcomes, and adverse events were investigated. Results: The median age was 64 (interquartile range, 54-72) years. All RFA procedures were successful. Clinical success was achieved in eight patients (72.7%). During the follow-up, eight patients (72.7%) showed
stent dysfunction, and the median patency after RFA was 50 days (95% confidence interval (CI): 34-not available (NA)). All
stent dysfunctions were successfully managed with ERCP. Ten patients died, and the median overall survival was 289 days (95% CI, 107-NA) from RFA to death. There was one case of mild
abdominal pain after the procedure without serious adverse events. Conclusions: As a rescue
therapy for occluded bilateral hilar
metal stents due to
tumor ingrowth, endoluminal RFA seemed to be safe and useful in selected patients.