Inoue Tadahisa, Yoshida Michihiro, Kachi Kenta, Kitano Rena, Ibusuki Mayu, Yamada Naoaki, Okumura Fumihiro, Naitoh Itaru
Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
Dig Dis Sci. 2025 Jul 28. doi: 10.1007/s10620-025-09265-8.
Intra-stent radiofrequency ablation (IS-RFA) is an alternative for treating ingrowth occlusions after metal stent (MS) deployment; however, its utility remains uncertain. This study aimed to examine the utility of IS-RFA compared with plastic stent (PS) placement for ingrowth occlusion after bilateral uncovered MS placement in patients with malignant hilar biliary obstruction.
In total, 148 patients met the inclusion criteria. The technical and clinical success rates, recurrent biliary obstruction (RBO), and adverse events were compared between the IS-RFA and PS placement groups. Propensity score matching was performed to adjust for between-group differences.
The technical success rate did not significantly differ between the IS-RFA and PS groups (92.8 versus 85.0%, P = 0.481), whereas the clinical success rate in the IS-RFA group was significantly lower than that in the PS group (70.3 versus 94.1%, P = 0.013). No significant group differences were observed in the rates of early and late adverse events. Among patients who achieved clinical success, the RBO incidence rate did not differ significantly between the groups at 42.3% and 56.3%, respectively (P = 0.429). However, the median time to RBO in the IS-RFA group was significantly longer than that in the PS group (163 days versus 89 days, P = 0.015). The IS-RFA group had a significantly lower mean total number of reintervention procedures than the PS group (1.4 versus 2.5, P = 0.038).
IS-RFA may be a useful option for ingrowth occlusion after bilateral MS placement. However, measures are needed to improve the clinical success rate for a standard treatment.
支架内射频消融术（IS-RFA）是治疗金属支架（MS）置入后增生性闭塞的一种替代方法；然而，其效用仍不确定。本研究旨在探讨在恶性肝门部胆管梗阻患者中，IS-RFA与置入塑料支架（PS）治疗双侧裸金属支架置入后增生性闭塞的效用。
共有148例患者符合纳入标准。比较了IS-RFA组和PS置入组的技术成功率、临床成功率、复发性胆管梗阻（RBO）及不良事件。采用倾向评分匹配法调整组间差异。
IS-RFA组和PS组的技术成功率无显著差异（92.8%对85.0%，P = 0.481），而IS-RFA组的临床成功率显著低于PS组（70.3%对94.1%，P = 0.013）。早期和晚期不良事件发生率在两组间无显著差异。在取得临床成功的患者中，两组的RBO发生率分别为42.3%和56.3%，无显著差异（P = 0.429）。然而，IS-RFA组RBO的中位时间显著长于PS组（163天对89天，P = 0.015）。IS-RFA组的平均再次干预程序总数显著低于PS组（1.4对2.5，P = 0.038）。
IS-RFA可能是双侧MS置入后增生性闭塞的一种有用选择。然而，需要采取措施提高标准治疗的临床成功率。
