TBA (24W106)

Is There A Role For Endobiliary Radiofrequency Ablation For Managing Blocked Metal Stents?

Author(s)

D Storan, B Awadelkarim, M Long, T Wong, N Elamin, N Philips, N Tehami, S Gardezi, J Geraghty, K Oppong, M Nayar, JS Leeds

Department(s)/Institutions

Freeman Hospital, Newcastle upon Tyne; Guy’s and St Thomas’ Hospital, London; Hammersmith Hospital, London; University Hospital Southampton; Gwent Liver Unit, Wales; Manchester University NHS Foundation Trust

Introduction

Endobiliary radiofrequency ablation (RFA) has been shown to improve survival when used prior to biliary stent insertion. The utility of RFA for treating occluded stents is uncertain but previous data shows it is feasible and may be beneficial.

Aims/Background

We report a multicentre experience of RFA in managing patients with occluded biliary metal stents.

Method

Retrospective analysis of patients with confirmed malignant biliary obstruction and an occluded stent was performed in 6 UK centres. Age, sex, cancer type and stage, probe type, adverse events, reintervention, oncological treatments and survival were recorded. Kaplan-Meier survival curves and Cox proportional hazards regression were performed to identify factors associated with survival and reintervention.

Results

131 patients were included in the study - 69 received RFA, 62 controls. There were no significant differences in demographics or oncological intervention and no difference in adverse events. Median time to reintervention was 96 days for RFA and 93 days for controls (p=0.79). There was no difference in unadjusted survival between the 2 groups (233 days RFA vs 187 days controls, p=0.43). Cox regression showed improved survival in those receiving post intervention chemotherapy (HR 0.45, p=0.0001). Adjusting the survival curves for chemotherapy showed significant survival advantage for those receiving RFA and chemotherapy (HR 0.36, p=0.0008) and those receiving chemotherapy alone (HR 0.46).

Conclusions

RFA is a safe adjunct in the management of occluded biliary metal stents due to tumour ingrowth but survival benefit appears synergistic with post-RFA chemotherapy. Further data are needed on effectiveness of different probe types, numbers of ablations used and effect upon quality of life.