Department of Gastroenterology & Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Endoscopy. 2017 Oct;49(10):977-982. doi: 10.1055/s-0043-113559. Epub 2017 Jul 21.
Biliary stenting of unresectable malignant bile duct obstruction is generally accepted as the standard of care but it can be hampered by tumor ingrowth and stent dysfunction. We aimed to test the feasibility, safety, and biliary patency rate of a new endoscopically applied intraductal radiofrequency ablation (RFA) device. Eighteen patients with inoperable malignant biliary obstruction underwent endoscopic retrograde cholangiopancreatography (ERCP)-directed RFA and stenting. Between December 2014 and November 2015, 18 patients underwent RFA to the intended region, with no complications within 3 months of the procedure. Bilirubin levels post-RFA and stenting decreased significantly (7.8 ± 1 mg/dL to 1.7 ± 0.4 mg/dL; < 0.001). At 90 and 180 days post-intervention, biliary patency was maintained in 80 % and 69 % of patients still alive at that time, respectively. The median overall stent patency was 110 days (range 16 - 374), with a median patient survival of 227 days (range 16 - 374). Intraductal RFA using a new device in patients with inoperable biliopancreatic cancer complicated by jaundice appeared feasible and safe with acceptable biliary patency. Randomized trials with prolonged follow-up are warranted.ClinTrials.gov: NCT02468076.
不可切除的恶性胆管梗阻的胆道支架置入通常被认为是标准的治疗方法，但它可能会受到肿瘤生长和支架功能障碍的阻碍。我们旨在测试一种新的内镜应用腔内射频消融（RFA）设备的可行性、安全性和胆道通畅率。18 例不可切除的恶性胆道梗阻患者接受了内镜逆行胰胆管造影（ERCP）引导下的 RFA 和支架置入。2014 年 12 月至 2015 年 11 月，18 例患者接受了预期区域的 RFA，术后 3 个月内无并发症。RFA 后和支架置入后的胆红素水平显著降低（7.8±1mg/dL 至 1.7±0.4mg/dL；<0.001）。在干预后 90 和 180 天，分别有 80%和 69%的仍存活患者的胆道保持通畅。中位总支架通畅时间为 110 天（范围 16-374），中位患者生存时间为 227 天（范围 16-374）。对于患有黄疸的不可切除的胰胆管癌患者，使用新设备进行经内镜腔内 RFA 似乎是可行和安全的，并且具有可接受的胆道通畅率。需要进行随机试验并进行长期随访。ClinicalTrials.gov：NCT02468076。
