Safety of intrabiliary radiofrequency ablation in cases of residual and recurrent neoplasia after endoscopic papillectomy

Abstract

Background and study aims

Intrabiliary radiofrequency ablation (IB-RFA) is a therapeutic option for cases of positive margin or recurrence after endoscopic papillectomy (EP) for superficial neoplasia. We report our experience concerning safety and efficiency of IB-RFA.

Patients and methods

This was a single tertiary center retrospective study. All patients who underwent IB-RFA indicated for residual or recurrent neoplasia after EP were included. We assessed morbidity (<30 days) and late complications (>30 days). Secondary outcomes were clinical success and late recurrence (absence of recurrence at the papillectomy site 12 months after IB-RFA and recurrence beyond 12 months, respectively).

Results

Twenty-five patients were included and underwent IB-RFA for deep positive margins (20/25, 80%) or relapse (5/25, 20%) and 40 sessions were delivered. The morbidity rate was 8% (2/24) (1 pancreatitis, 1 bleeding). Acute pancreatitis was significantly more common in the absence of pancreatic stenting (0% vs. 22%, P=0.046). One patient for whom pancreatic stenting failed died from acute severe pancreatitis in the first month (mortality rate=4%). Late complications occurred in 12 of 24 patients (50%) concerning only biliary stricture, all of which were managed endoscopically without sequelae. The clinical success rate was 92% (22/24), and late recurrence occurred in two of 24 patients (8%).

Conclusions

IB-RFA is relatively safe and efficient in cases of residual or recurrent neoplasia after EP and is an alternative to surgery in well-selected cases. Biliary stricture occurred frequently (50%) but could be managed endoscopically without sequelae in all cases. In cases of pancreatic stenting failure and because of the risk of severe and potentially lethal acute pancreatitis, IB-RFA should be postponed.

Keywords

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

Publication History

Received: 16 January 2024

Accepted after revision: 18 September 2024

Accepted Manuscript online:
25 November 2024

Article published online:
13 January 2025

• References

• 1 Suzuki K, Kantou U, Murakami Y. et al. Two cases with ampullary cancer who underwent endoscopic excision. Prog Dig Endosc 1983; 23: 236-239
• 2 Vanbiervliet G, Strijker M, Arvanitakis M. et al. ESGE Guidelines. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 429-448
• 3 Chathadi KV, Khashab MA, Acosta RD. et al. ASGE Standards of Practice Committee. The role of endoscopy in ampullary and duodenal adenomas Gastrointest Endosc 2015; 82: 773–781. https://pubmed.ncbi.nlm.nih.gov/?term=ASGE+Standards+of+Practice+Committee%25255BCorporate+Author%25255D
• 4 Napoleon B, Gincul R, Ponchon T. et al. Endoscopic papillectomy for early ampullary tumors: long-term results from a large multicenter prospective study. Endoscopy 2014; 46: 127-134
• 5 Kang SH, Kim KH, Kim TN. et al. Therapeutic outcomes of endoscopic papillectomy for ampullary neoplasms: retrospective analysis of a multicenter study. BMC Gastroenterology 2017; 17: 69
• 6 Van der Wiel SE, Poley JW, Koch AD. et al. Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study. Surg Endosc 2019; 33: 1180-1188
• 7 Sakai A, Tsujimae M, Masuda A. et al. Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy. World J Gastroenterol 2019; 25: 1387-1397
• 8 Mattevi C, Garnier J, Marchese U. et al. Has the nonresection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?. BMC Surgery 2020; 20: 176
• 9 Song J, Liu H, Li Z. et al. Long-term prognosis of surgical treatment for early ampullary cancers and implications for local ampullectomy. BMC Surgery 2015; 15: 32
• 10 Farges O, Bendersky N, Truant S. et al. The theory and practice of pancreatic surgery in France. Ann Surg 2017; 266: 797-804
• 11 Bohnacker S, Seitz U, Nguyen D. et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc 2005; 62: 551-560
• 12 Ridtitid W, Ten D, Schmidt S. et al. Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up. Gastrointest Endosc 2014; 79: 289-296
• 13 Perez-Cuadrado-Robles E, Piessevaux H, Moreels TG. et al. Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms. UEG Journal 2019; 7: 369-376
• 14 Camus M, Napoleon 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
• 15 Rustagi T, Irani S, Reddy D. et al. Radiofrequency ablation for intraductal extension of ampullary neoplasms. Gastrointest Endosc 2016; 86: 170-176
• 16 Tringali A, Matteo M, 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
• 17 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
• 18 Nass KJ, Zwager LW, Van Der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085
• 19 Chun JW, Woo SM, Han M. et al. Prolonged patency of fully covered self-expandable metal stents with an externally anchored plastic stent in distal malignant biliary obstruction. Endoscopy 2023; 55: 563-568