1 Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey, 06100.
2 Department of General Surgery, Hacettepe University School of Medicine, Ankara, Turkey.
AJR Am J Roentgenol. 2019 Mar;212(3):W83-W91. doi: 10.2214/AJR.18.19751. Epub 2019 Jan 8.
The purpose of this study is to evaluate the safety and efficacy of endobiliary radiofrequency ablation (RFA) in the percutaneous management of benign bilioenteric anastomosis strictures that are refractory to balloon dilatation and long-term drainage.
Twenty-one patients (11 men) with a mean age of 47.9 years (range, 26-73 years) underwent percutaneous balloon dilatation and long-term drainage for benign bilioenteric anastomosis strictures. Endobiliary RFA was performed in six patients (four men; mean age, 53.1 years; range, 43-63 years) whose strictures did not respond to balloon dilatation and long-term drainage.
Presenting symptoms were jaundice (n = 21), pain (n = 19), pruritus (n = 17), and cholangitis (n = 15). The symptoms appeared 1384 days (range, 4-7592 days) after surgery. The technical success rate was 100%. The overall clinical success rate was 95.2% (20/21) with a mean follow-up of 67.3 months (range, 9-148 months) after catheter removal. In 15 patients, associated biliary stones were removed. Two patients with recurrent strictures were successfully retreated. Endobiliary RFA was successful and catheter removal could be achieved in all six patients (100%) whose disease did not respond to multiple balloon dilatation sessions and long-term drainage. The mean symptom-free period after endobiliary RFA and catheter removal was 430 days (range, 270-575 days). One patient with refractory disease (4.7%), for whom endobiliary RFA was not performed, underwent surgery. There were no major complications.
Endobiliary ablation may be used safely and effectively in the percutaneous management of benign bilioenteric anastomosis strictures that are refractory to balloon dilatation and long-term drainage, with promising results.
本研究旨在评估经皮内镜下射频消融(endobiliary radiofrequency ablation，RFA)在治疗经球囊扩张和长期引流无效的良性胆肠吻合口狭窄中的安全性和疗效。
21 例（11 例男性）患者，平均年龄 47.9 岁（范围，26-73 岁），因良性胆肠吻合口狭窄行经皮球囊扩张和长期引流治疗。6 例（4 例男性；平均年龄 53.1 岁；范围，43-63 岁）患者因狭窄对球囊扩张和长期引流无反应而行内镜下 RFA。
首发症状为黄疸（n=21）、疼痛（n=19）、瘙痒（n=17）和胆管炎（n=15）。症状出现于术后 1384 天（范围，4-7592 天）。技术成功率为 100%。总体临床成功率为 95.2%（20/21），在拔除导管后平均随访 67.3 个月（范围，9-148 个月）。15 例患者同时取出胆管结石。2 例复发狭窄患者成功再治疗。6 例（100%）疾病对多次球囊扩张和长期引流无反应的患者，行内镜下 RFA 治疗均成功，且能拔除导管。内镜下 RFA 及拔除导管后无症状期平均为 430 天（范围，270-575 天）。1 例（4.7%）难治性疾病患者未行内镜下 RFA，行手术治疗。无重大并发症。
经皮内镜下 RFA 治疗经球囊扩张和长期引流无效的良性胆肠吻合口狭窄安全有效，效果良好。
