So Hoonsub, Oh Chi Hyuk, Song Tae Jun, Lee Hyun Woo, Hwang Jun Seong, Ko Sung Woo, Oh Dongwook, Park Do Hyun, Lee Sang Soo, Seo Dong-Wan, Lee Sung Koo, Kim Myung-Hwan
Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul 02453, Korea.
J Clin Med. 2021 Mar 1;10(5):952. doi: 10.3390/jcm10050952.
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. 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. 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. 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.
射频消融术（RFA）是一种姑息治疗方法，以其在内镜下治疗恶性胆管梗阻中的应用而闻名。它可能是一种治疗因肿瘤长入导致金属支架功能障碍的有效挽救方法。本研究旨在探讨腔内RFA治疗恶性肝门部胆管梗阻患者因肿瘤长入导致双侧肝门部金属支架闭塞的可行性和安全性。2016年3月至2018年6月，纳入11例因肿瘤长入导致双侧肝门部金属支架闭塞的不可切除恶性肝门部胆管狭窄患者。通过新型温控导管，经内镜逆行胰胆管造影（ERCP），以7W功率设置120秒，目标温度80°C进行腔内RFA。对患者的人口统计学、临床结果和不良事件进行了调查。中位年龄为64岁（四分位间距，54 - 72岁）。所有RFA手术均成功。8例患者（72.7%）取得临床成功。随访期间，8例患者（72.7%）出现支架功能障碍，RFA术后中位通畅时间为50天（95%置信区间（CI）：34 - 不可用（NA））。所有支架功能障碍均通过ERCP成功处理。10例患者死亡，从RFA到死亡的中位总生存期为289天（95%CI，107 - NA）。术后有1例患者出现轻度腹痛，无严重不良事件。作为因肿瘤长入导致双侧肝门部金属支架闭塞的挽救治疗，腔内RFA在选定患者中似乎是安全且有用的。
