P205 Safety and efficacy of endo- biliary radiofrequency ablation for stent occlusion: a case series
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Résumé
<h3>Introduction</h3> Endo-biliary radiofrequency ablation (RFA) is a novel minimally invasive intervention to treat stent occlusion in malignant biliary strictures<sup>1</sup>. Advances in oncological therapies have improved survival and tumour ingrowth into uncovered self-expanding metal stents (UcSEMS) is common and strategies to manage this are limited<sup>2</sup>. We aimed to determine the clinical outcomes of endo-biliary RFA using ELRA<sup>TM</sup> probe (Taewoong) in patients with UcSEMS occlusion. <h3>Methods</h3> Retrospective data was collected from February 2020 to March 2023 at St Thomas’ Hospital. <h3>Results</h3> 28 endo-biliary RFA’s (figure 1) were performed in 12 patients for occluded UcSEMS over this period, delivered by 3 operators. M:F ratio was 7:5 and mean age was 71. Aetiology was cholangiocarcinoma in 5, pancreatic cancer in 4, gallbladder malignancy in 1, hepatocellular cancer in 1 and metastatic breast cancer in 1. Excluding two recent cases, 60% required multiple RFA interventions. The median number of RFA’s was 2, with one patient requiring 9 sessions. One patient was excluded as there was significant parenchymal disease in addition to UcSEMS occlusion and despite RFA, there was progression in liver metastasis. For patients with bilirubin monitoring post RFA, 11 (100%) procedures resulted in a reduction in bilirubin between 1–4 weeks. The average reduction in bilirubin was 61.4% (6/11 patients) at week 1 and 77.4% (9/11 patients) at week 2–4. Excluding 2 recent cases, survival was 90% at 30 days post procedure, and 70% at 90 days. Survival was 100% at 90 days for cholangiocarcinoma. The patient requiring 9 sessions (not on chemotherapy), survived for 18 months with significantly improved quality of life. There were no recorded complications. Technical difficulties were encountered in 2 cases due to impedance in bilobar stents with a Y configuration due to contact of the probe with metal at the hilum. <h3>Conclusions</h3> Endo-biliary RFA had good technical and clinical success with measurable reduction in bilirubin in patients with UcSEMS occlusion without any complications in our cohort. It is difficult to say if survival is purely due to biliary drainage or if there is an anti-tumour effect with RFA, especially given the 100% survival at 3 months in patients with cholangiocarcinoma. Additional data from randomised controlled trials is required to assess the role of RFA in malignant strictures.
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle