Radiofrequency ablation for ampullary neoplasia with intraductal extension after endoscopic papillectomy: Systematic review and meta-analysis

Abstract

Background and study aims Noninvasive ampullary neoplasms may be removed by surgery or endoscopy. However, given the morbidity and mortality associated with surgery, endoscopic papillectomy (EP) is the preferred approach. Radiofrequency ablation (RFA) after EP has emerged as a promising alternative therapy to avoid surgery after incomplete EP. Our goal was to evaluate the efficacy and safety of RFA for residual or recurrent lesions with intraductal extension after endoscopic papillectomy.

Patients and methods The inclusion criteria include clinical trials, cohort studies, and case series evaluating patients with residual or recurrent lesions with intraductal extension after EP treated with RFA. Case reports, duplicated data, and studies with follow-up periods < 10 months were excluded. The metanalysis evaluated adverse events, surgical conversion rate, clinical success and recurrence.

Results Seven studies were selected, totaling 124 patients. RFA was associated with a clinical success rate of 75.7% (95% confidence interval [CI] 65.0-88.0%; I² = 23.484) in a mean follow-up period < 10 months. However, the biliary stricture rate was 22.2% (95% CI 12.1-28.4%; I² = 61.030), 14.3% of pancreatitis (95% CI 8.8-22.3%; I² < 0.001), 7.0% of cholangitis (95% CI 3.3-14.5%; I² < 0.001), 4.0% of bleeding (95% CI 1.7-9.3%; I² < 0.001), and recurrence of 24.3% (95% CI 16.0-35.0%; I² = 23.484).

Conclusions RFA is feasible and appears to be effective for managing residual or recurrent lesions with intraductal extension after EP. However, long-term follow-up and high-quality studies are required to confirm our findings.

Keywords

RFA and ablative methods - Strictures - Endoscopy Upper GI Tract - Pancreatobiliary (ERCP/PTCD)

Publication History

Received: 20 July 2023

Accepted after revision: 06 December 2023

Accepted Manuscript online:
11 December 2023

Article published online:
28 March 2024

• References

• 1 Vanbiervliet G, Strijker M, Arvanitakis M. et al. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 429-448
• 2 Fritzsche JA, Fockens P, Barthet M. et al. Expert consensus on endoscopic papillectomy using a Delphi process. Gastrointest Endosc 2021; 94: 760-773.e18
• 3 Itoi T, Ryozawa S, Katanuma A. et al. Clinical practice guidelines for endoscopic papillectomy. Digest Endosc 2022; 34: 394-411
• 4 Yang J, Han S, Zhou H. et al. The efficacy and safety of endoscopic papillectomy combined with endobiliary radiofrequency ablation for ampullary neoplasms with intraductal biliary extension. Techniq Innovations Gastrointest Endosc 2022; 24: 240-245
• 5 Binmoeller KF, Boaventura S, Ramsperger K. et al. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc 1993; 39: 127-131
• 6 Jordan P. Treatment of ampullary villous adenomas that may harbor carcinoma. J Gastrointest Surg 2002; 6: 770-775
• 7 TranTin C, Vitale GC. et al. Ampullary tumors: endoscopic versus operative management. Surg Innovation 2004; 11: 255-263
• 8 Ceppa EP, Burbridge RA, Rialon KL. et al. Endoscopic versus surgical ampullectomy. Annals Surgery 2013; 257: 315-322
• 9 Gracient A, Delcenserie R, Chatelain D. et al. Endoscopic or surgical ampullectomy for intramucosal ampullary tumor: the patient populations are not the same. J Visceral Surgery 2020; 157: 183-191
• 10 Norton ID, Gostout CJ, Baron TH. et al. Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc 2002; 56: 239-243
• 11 Nam K, Song TJ, Kim RE. et al. Usefulness of argon plasma coagulation ablation subsequent to endoscopic snare papillectomy for ampullary adenoma. Digest Endosc 2018; 30: 485-492
• 12 Camus M, Napoléon B, Vienne A. et al. Efficacy and safety of endobiliary radiofrequency ablation for the eradication of residual neoplasia after endoscopic papillectomy: a multicenter prospective study. Gastrointest Endosc 2018; 88: 511-518
• 13 Rustagi T, Irani S, Reddy DN. et al. Radiofrequency ablation for intraductal extension of ampullary neoplasms. Gastrointest Endosc 2017; 86: 170-176
• 14 Tringali A, Matteo MV, Orlandini B. et al. Radiofrequency ablation for intraductal extension of ampullary adenomatous lesions: proposal for a standardized protocol. Endosc Int Open 2021; 09: E749-E755
• 15 Cho SH, Oh D, Song TJ. et al. Long-term outcomes of endoscopic intraductal radiofrequency ablation for ampullary adenoma with intraductal extension after endoscopic snare papillectomy. Gut Liver 2023; 17: 638-646
• 16 Haen SP, Pereira PL, Salih HR. et al. More than just tumor destruction: immunomodulation by thermal ablation of cancer. Clin Develop Immunol 2011; 2011: 1-19
• 17 Ali MY, Grimm CF, Ritter M. et al. Activation of dendritic cells by local ablation of hepatocellular carcinoma. J Hepatol 2005; 43: 817-822
• 18 Weismüller TJ. Role of intraductal RFA: A novel tool in the palliative care of perihilar cholangiocarcinoma. Visceral Mede 2021; 37: 39-47
• 19 Page MJ, Moher D, Bossuyt PM. et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021;
• 20 GRADEpro GDT: GRADEpro Guideline Development Tool Software. McMaster University and Evidence Prime, 2023. Available from gradepro.org.
• 21 Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Method 2005; 5: 13
• 22 Borenstein M, Hedges L, Higgins J. et al. Comprehensive Meta-Analysis Version 4. Englewood, NJ: Biostat; 2022
• 23 Choi YH, Yoon SB, Chang JH. et al. The safety of radiofrequency ablation using a novel temperature-controlled probe for the treatment of residual intraductal lesions after endoscopic papillectomy. Gut Liver 2021; 15: 307-314
• 24 Dahel Y, Giovannini M, Pesenti C. et al. Efficacy of biliary radiofrequency ablation for the treatment of residual and recurrence neoplasia after endoscopic papillectomy. Endoscopy 2023; 55: 51-52
• 25 Bruwier L, Meunier C, Leuhg-Ki E. et al. Can we ameliorate the safety of intraductal radiofrequency ablation for persistent dysplasia after endoscopic ampullectomy?. Endoscopy 2020; 52: 133-134
• 26 Fritzsche JA, Klein A, Beekman MJ. et al. Endoscopic papillectomy; a retrospective international multicenter cohort study with long-term follow-up. Surg Endosc 2021; 35: 6259-6267
• 27 Sahar N, Krishnamoorthi R, Kozarek RA. et al. Long-term outcomes of endoscopic papillectomy for ampullary adenomas. Digest Dis Sci 2020; 65: 260-268
• 28 Alvarez-Sanchez M-V, Oria I, Luna OB. et al. Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?. Surg Endosc 2017; 31: 1564-1572
• 29 Fernández Moro C, Fernandez-Woodbridge A, Alistair D’souza M. et al. Immunohistochemical typing of adenocarcinomas of the pancreatobiliary system improves diagnosis and prognostic stratification. PLoS One 2016; 11: e0166067
• 30 Yamamoto K, Itoi T, Sofuni A. et al. Expanding the indication of endoscopic papillectomy for T1a ampullary carcinoma. Digest Endosc 2019; 31: 188-196
• 31 Salmi S, Ezzedine S, Vitton V. et al. Can papillary carcinomas be treated by endoscopic ampullectomy?. Surg Endosc 2012; 26: 920-925
• 32 Yoon SM, Kim M-H, Kim MJ. et al. Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy?. Gastrointest Endosc 2007; 66: 701-707
• 33 Khoury T, Sbeit W, Fusaroli P. et al. Safety and efficacy of endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine neoplasms: Systematic review and meta-analysis. Digest Endosc 2023;
• 34 Armellini E, Facciorusso A, Crinò SF. Efficacy and safety of endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors: a systematic review and metanalysis. Medicina (B Aires) 2023; 59: 359
• 35 Sofi AA, Khan MA, Das A. et al. Radiofrequency ablation combined with biliary stent placement versus stent placement alone for malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 2018; 87: 944-951.e1
• 36 Yoon SM, Kim M-H, Kim MJ. et al. Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy?. Gastrointest Endosc 2007; 66: 701-707
• 37 Lee YN, Jeong S, Choi HJ. et al. The safety of newly developed automatic temperature-controlled endobiliary radiofrequency ablation system for malignant biliary strictures: A prospective multicenter study. J Gastroenterol Hepatol 2019;
• 38 Dumonceau J-M, Kapral C, Aabakken L. et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 127-149