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Endoscopy 2025; 57(03): 272-281
DOI: 10.1055/a-2378-9533
Systematic review

Endoluminal radiofrequency ablation with stenting versus stenting alone in patients with malignant biliary obstruction: a meta-analysis of randomized trials

Daryl Ramai
1   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
,
Marcello Maida 
2   Gastroenterology, S. Elia - Raimondi Hospital, Caltanissetta, Italy
3   Medicine and Surgery, Kore University of Enna, Enna, Italy (Ringgold ID: RIN217140)
,
Eric R. Smith
4   Medicine, Baylor Scott & White Health, Dallas, United States (Ringgold ID: RIN423342)
,
Yichen Wang 
5   Hospital Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States (Ringgold ID: RIN14640)
,
Marco Spadaccini
6   Endoscopy Unit, Istituto Clinico Humanitas, Rozzano, Italy (Ringgold ID: RIN9268)
7   Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)
,
Melissa Previtera
8   Donald C. Harrison Health Sciences Library, University of Cincinnati Libraries, Cincinnati, United States (Ringgold ID: RIN491495)
,
Saurabh Chandan 
9   Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, United States (Ringgold ID: RIN25095)
,
Yuting Huang 
10   Gastroenterology and Hepatology, Mayo Clinic in Florida, Jacksonville, United States (Ringgold ID: RIN156400)
,
Salih Tokmak 
11   Gastroenterology, Duzce University, Duzce, Turkey (Ringgold ID: RIN121595)
,
Peter Bhandari
12   Medicine, Lenox Hill Hospital, New York, United States (Ringgold ID: RIN5945)
,
Jason DuBroff
1   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
,
Christopher Ko
1   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
,
John D. Morris
1   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
,
Giovanni Marasco 
13   Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)
14   Medicine, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Stefano Francesco Crinó 
15   Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, University of Verona, Verona, Italy (Ringgold ID: RIN19051)
,
Antonio Facciorusso 
16   Medical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy (Ringgold ID: RIN18972)
,
Benedetto Mangiavillano 
17   Gastrointestinal Endoscopy, Istituto Clinico Mater Domini Casa di Cura Privata SpA, Castellanza, Italy (Ringgold ID: RIN9348)
,
Mouen A Khashab
18   Therapeutic Endoscopy, Division of Gastroenterology, Johns Hopkins Medical Institutions Campus, Baltimore, United States (Ringgold ID: RIN1501)
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Abstract

Background: Endoluminal radiofrequency ablation (RFA) is a palliative treatment for patients suffering from malignant biliary obstruction (MBO). We aimed to conduct a meta-analysis to evaluate the impact of RFA on stent patency, patient survival, and adverse events.

Methods: Major databases were searched through December 2023 for patients who had undergone stenting with or without RFA for extrahepatic MBO. A random-effects model was used for analysis, with results expressed as relative risk ratios (RRs) with 95%CIs.

Results: Nine RCTs involving 750 subjects with MBO (374 RFA plus stent vs. 376 stent only) were included. Meta-analysis revealed similar risks of stent patency at 3 months (RR 1.01, 95%CI 0.92–1.11; I 2 = 4%) for RFA plus stenting vs. stent only. Meta-analysis showed improved survival at 6 months (RR 0.84, 95%CI 0.73–0.96; I 2 = 21%; P = 0.01) for RFA plus stenting vs. stent only. Subgroup analysis comparing plastic vs. uncovered metal stents showed that stent patency was unaffected at 3 months (RR 1.06, 95%CI 0.91–1.23; I 2 = 17%). Subgroup analysis showed that patients with cholangiocarcinoma experienced an overall survival benefit with RFA plus stenting vs. stenting alone (P < 0.001); however, stent patency remained unaffected (P = 0.08). An increased incidence of cholecystitis was noted with RFA plus stenting vs. stenting alone (5.1% [95%CI 3.1%–7.8%] vs. 0.3% [95%CI 0.01%–1.5%], respectively).

Conclusion: Combining endoluminal RFA and stenting may improve overall survival in patients with MBO. RFA did not significantly impact stent patency.

Supplementary Material



Publication History

Received: 20 February 2024

Accepted after revision: 02 August 2024

Accepted Manuscript online:
02 August 2024

Article published online:
06 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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