Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
Dig Endosc. 2014 Jul;26(4):581-5. doi: 10.1111/den.12225. Epub 2014 Jan 9.
Endoscopic management of benign biliary stricture (BBS) remains challenging. There is no reported method for the amelioration of biliary fibroplasia endoscopically. We report our initial experience of radiofrequency ablation (RFA) for the management of BBS.
Nine patients with BBS (postoperation stricture four, liver transplant three, and chronic inflammation two), seven of whom had previously unsuccessful endoscopic or percutaneous interventions, were enrolled. Intraductal bipolar RFA was delivered at power of 10 W for 90 s per stricture segment, followed by balloon dilatation with/without stent placement.
All patients had immediate stricture improvements after RFA. No severe adverse event occurred except for one patient with mild post-endoscopic retrograde cholangiopancreatography pancreatitis. During median (SD) follow-up duration of 12.6 (3.9) months, BBS resolution without the need for further stenting was achieved in four patients whereas two patients had stent(s) in situ waiting scheduled removal. However, one patient had stricture relapse after initial resolution, one underwent surgery, and another patient died of other cause.
Endobiliary RFA appears to be safe and effective for the treatment of BBS, especially for refractory cases. Further studies are warranted.
良性胆道狭窄（BBS）的内镜处理仍然具有挑战性。目前尚无报道的方法可以改善胆道纤维增生的内镜下表现。我们报告了射频消融（RFA）在 BBS 治疗中的初步经验。
共纳入 9 例 BBS 患者（术后狭窄 4 例，肝移植 3 例，慢性炎症 2 例），其中 7 例先前的内镜或经皮介入治疗失败。每个狭窄段给予 10 W 功率的腔内双极 RFA，持续 90 s，随后进行球囊扩张加/不加支架置入。
所有患者在 RFA 后立即出现狭窄改善。除 1 例患者出现轻度内镜逆行胰胆管造影后胰腺炎外，无严重不良事件发生。中位（标准差）随访 12.6（3.9）个月，4 例患者无需进一步支架置入即可解决 BBS，2 例患者支架在位等待择期取出。然而，1 例患者初始缓解后出现狭窄复发，1 例患者接受了手术，另 1 例患者因其他原因死亡。
经内镜胆道内 RFA 似乎是一种安全有效的治疗 BBS 的方法，尤其是对难治性病例。需要进一步研究。
