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DOI: 10.1055/a-2378-9533
Endoluminal radiofrequency ablation with stenting versus stenting alone in patients with malignant biliary obstruction: a meta-analysis of randomized trials
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.
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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References
- 1 Qumseya BJ, Jamil LH, Elmunzer BJ. et al. ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction. Gastrointest Endosc 2021; 94: 222-234
- 2 Artifon EL, Sakai P, Cunha JE. et al. Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer. Am J Gastroenterol 2006; 101: 2031-2037
- 3 Figueroa-Barojas P, Bakhru MR, Habib NA. et al. Safety and efficacy of radiofrequency ablation in the management of unresectable bile duct and pancreatic cancer: a novel palliation technique. J Oncol 2013; 2013: 910897
- 4 Sharaiha RZ, Sethi A, Weaver KR. et al. Impact of radiofrequency ablation on malignant biliary strictures: results of a collaborative registry. Dig Dis Sci 2015; 60: 2164-2169
- 5 Hu B, Gao D, Zhang X. et al. Endobiliary radiofrequency ablation improve overall survival of cholangiocarcinoma: a multi-center randomized control study. Gastrointest Endosc 2016; 83: AB126-AB126
- 6 Yang J, Wang J, Zhou H. et al. Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial. Endoscopy 2018; 50: 751-760
- 7 Tarar ZI, Farooq U, Gandhi M. et al. Effect of radiofrequency ablation in addition to biliary stent on overall survival and stent patency in malignant biliary obstruction: an updated systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2023; 35: 646-653
- 8 Jarosova J, Zarivnijova L, Cibulkova I. et al. Endoluminal radiofrequency ablation in patients with malignant biliary obstruction: a randomised trial. Gut 2023; 72: 2286-2293
- 9 Albers D, Schmidt A, Schiemer M. et al. Impact of endobiliary radiofrequency ablation on biliary drainage in patients with malignant biliary strictures treated with uncovered self-expandable metal stents: a randomized controlled multicenter trial. Gastrointest Endosc 2022; 96: 970-979
- 10 Sterne JAC, Savović J, Page MJ. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898
- 11 Der Simonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
- 12 Sutton AJ, Abrams KR, Jones DR. An illustrated guide to the methods of meta-analysis. J Eval Clin Pract 2001; 7: 135-148
- 13 Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 2009; 172: 137-159
- 14 Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011; 342: d549
- 15 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
- 16 Kanwal F, White D. Systematic reviews and meta-analyses in clinical gastroenterology and hepatology. Clin Gastroenterol Hepatol 2012; 10: 1184-1186
- 17 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence--inconsistency. J Clin Epidemiol 2011; 64: 1294-1302
- 18 Easterbrook PJ, Berlin JA, Gopalan R. et al. Publication bias in clinical research. Lancet 1991; 337: 867-872
- 19 Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455-463
- 20 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
- 21 Kang H, Chung MJ, Cho IR. et al. Efficacy and safety of palliative endobiliary radiofrequency ablation using a novel temperature-controlled catheter for malignant biliary stricture: a single-center prospective randomized phase II TRIAL. Surg Endosc 2021; 35: 63-73
- 22 Kang H, Han SY, Cho JH. et al. Efficacy and safety of temperature-controlled intraductal radiofrequency ablation in advanced malignant hilar biliary obstruction: A pilot multicenter randomized comparative trial. J Hepatobiliary Pancreat Sci 2022; 29: 469-478
- 23 Gao DJ, Yang JF, Ma SR. et al. Endoscopic radiofrequency ablation plus plastic stent placement versus stent placement alone for unresectable extrahepatic biliary cancer: a multicenter randomized controlled trial. Gastrointest Endosc 2021; 94: 91-100
- 24 Teoh AY, Cheung SY, Chong C. et al. 613 endoscopic biliary radiofrequency ablation for malignant distal common bile duct strictures does not improve survival. A randomized controlled trial. Gastrointest Endosc 2018; 87: AB104-AB105
- 25 Andrasina T, Rohan T, Panek J. et al. The combination of endoluminal radiofrequency ablation and metal stent implantation for the treatment of malignant biliary stenosis - Randomized study. Eur J Radiol 2021; 142: 109830
- 26 Li JS, Fang J, Li ZS. Endoluminal radiofrequency ablation prior to stenting for malignant biliary obstruction: really time to say goodbye?. Gut 2024; 73: 1402-1403
- 27 Baria K, De Toni EN, Yu B. et al. Worldwide incidence and mortality of biliary tract cancer. Gastro Hep Advances 2022; 1: 618-626
- 28 Wardell CP, Fujita M, Yamada T. et al. Genomic characterization of biliary tract cancers identifies driver genes and predisposing mutations. J Hepatol 2018; 68: 959-969
- 29 Law R, Pai M, Baron TH. et al. The effects of endobiliary radiofrequency ablation in two patients with pancreatic cancer: Gross and microscopic findings. Gastrointestinal Intervention 2013; 2: 124-126
- 30 Kallis Y, Phillips N, Steel A. et al. Analysis of endoscopic radiofrequency ablation of biliary malignant strictures in pancreatic cancer suggests potential survival benefit. Dig Dis Sci 2015; 60: 3449-3455
- 31 Sharaiha RZ, Natov N, Glockenberg KS. et al. Comparison of metal stenting with radiofrequency ablation versus stenting alone for treating malignant biliary strictures: is there an added benefit?. Dig Dis Sci 2014; 59: 3099-3102
- 32 Ito F, Ku AW, Bucsek MJ. et al. Immune adjuvant activity of pre-resectional radiofrequency ablation protects against local and systemic recurrence in aggressive murine colorectal cancer. PLoS One 2015; 10: e0143370
- 33 Jarosova J, Macinga P, Krupickova L. et al. Impact of endoluminal radiofrequency ablation on immunity in pancreatic cancer and cholangiocarcinoma. Biomedicines 2022; 10: 1331
- 34 Gaddam S, Coté GA. The importance of the “endoscopic oncologist” in the treatment of nonoperable cholangiocarcinoma. Gastrointest Endosc 2020; 92: 1213-1215
- 35 Itoi T, Isayama H, Sofuni A. et al. Evaluation of effects of a novel endoscopically applied radiofrequency ablation biliary catheter using an ex-vivo pig liver. J Hepatobiliary Pancreat Sci 2012; 19: 543-547
- 36 Pillai K, Akhter J, Chua TC. et al. Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model. Medicine 2015; 94: e580
- 37 Inoue T, Yoneda M. Updated evidence on the clinical impact of endoscopic radiofrequency ablation in the treatment of malignant biliary obstruction. Dig Endosc 2022; 34: 345-358
- 38 Di Girolamo E, Belli A, Ottaiano A. et al. Impact of endobiliary radiofrequency ablation on survival of patients with unresectable cholangiocarcinoma: a narrative review. Front Oncol 2023; 13: 1077794
- 39 Suk KT, Kim HS, Kim JW. et al. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc 2006; 64: 522-529