Cho Jae Hee, Jang Sung Ill, Do Min Young, Lee Dong Ki
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2021 Oct 25;78(4):205-212. doi: 10.4166/kjg.2021.121.
Malignant biliary strictures are caused by pancreatobiliary cancer and other metastatic malignancies. Most of them are unresectable at diagnosis with a dismal prognosis. Various new ablation methods have been introduced. Of them, ERCP-guided intraductal radiofrequency ablation (ID-RFA) appears to be the most promising minimally invasive endoscopic treatment by delivering a high-frequency alternating current to the target tissue, leading to coagulative necrosis. Thus far, many studies have provided evidence that ERCP-guided ID-RFA is a safe, feasible, and effective treatment modality for stent patency and overall survival. Compared to other ablation treatments, ERCP-guided ID-RFA has several advantages, including ease of delivery, controlled application of thermal energy, low cost, and fewer systemic side effects with an acceptable safety profile. Therefore, ERCP-guided ID-RFA can be considered an adjunctive treatment for the palliation of unresectable malignant biliary strictures. On the other hand, the decision of local ablation treatment should be individualized by multidisciplinary team support due to the lack of comparative studies.
恶性胆管狭窄由胰胆管癌和其他转移性恶性肿瘤引起。大多数患者在诊断时无法切除，预后不佳。已引入了多种新的消融方法。其中，内镜逆行胰胆管造影（ERCP）引导下的导管内射频消融（ID-RFA）似乎是最有前景的微创内镜治疗方法，它通过向目标组织输送高频交流电，导致凝固性坏死。到目前为止，许多研究已证明ERCP引导下的ID-RFA是一种安全、可行且有效的治疗方式，可维持支架通畅并提高总体生存率。与其他消融治疗相比，ERCP引导下的ID-RFA具有多个优点，包括易于实施、热能应用可控、成本低以及全身副作用较少且安全性可接受。因此，ERCP引导下的ID-RFA可被视为缓解不可切除恶性胆管狭窄的辅助治疗方法。另一方面，由于缺乏对照研究，局部消融治疗的决策应在多学科团队支持下进行个体化。
