ENDOBILIARY RADIOFREQUENCY ABLATION FOR REFRACTORY BENIGN STRICTURE: AN EUROPEAN PILOT STUDY

Aims Endoscopic treatment of benign biliary stricture (BBS) remains challenging with 15% of recurrence ater metallic or multiple plastic stenting. We experimented endobiliary radiofrequency ablation (ERFA) with the aim to eradicate biliary fibroplasia endoscopically. We report our first experience of ERFA in the management of refractory BBS.

Methods 10patients with BBS (7 postoperative strictures, 2 chronic inflammatory strictures and 1 post stenting stricture) were treated from august 2014 to august 2019. All had previously unsuccessful endoscopic treatment with dilatations (1,75 [0–3]) and plastic or metallic stenting during a median of 18 months (9–48). Bipolar ERFA was delivered at power of 10 W for 90 seconds per stricture segment, followed by a 10 mm balloon dilatation without stent placement. Data were collected on technical success (ERFA delivery), clinical success (stricture resolution), adverse events and follow-up.

Results ERFA was performed in 10 patients (9 men) with a median age of 58 years (range 20–81). All patients had stricture resolution after ERFA. No severe adverse event occurred with only a case of short abdominal mild pain. The median follow-up is 34 months.

BBS resolution without the need for further stenting was achieved in 8 patients. The 2 patients with inflammatory stricture had BBS relapse after initial resolution at 10 and 12 months, one underwent surgery, the other metallic stenting for 9 months with no further relapse at 2 years.

Conclusions ERFA appears to be a safe and effective treatment for refractory BBS, especially for postoperative strictures. Further studies are warranted.