Endoscopic Ultrasound-Guided Antegrade Radiofrequency Ablation and Metal Stenting With Hepaticoenterostomy for Malignant Biliary Obstruction: A Prospective Preliminary Study
Open Access
- 1 October 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical and Translational Gastroenterology
- Vol. 11 (10), e00250
- https://doi.org/10.14309/ctg.0000000000000250
Abstract
OBJECTIVES: Endobiliary radiofrequency ablation (RFA) for malignant biliary obstruction is a promising option for improving biliary stent patency, but its efficacy and safety with endoscopic ultrasound (EUS)-guided biliary drainage are uncertain. We examined the feasibility of EUS-guided hepaticoenterostomy with antegrade stenting (EUS-HEAS) and RFA in patients with unresectable malignant biliary obstruction. METHODS: This was a prospective, single-center, single-arm, preliminary study. Twenty patients who met the eligibility criteria for inclusion between August 2018 and January 2020 were enrolled. We evaluated the technical success, functional success, recurrent biliary obstruction (RBO), and adverse events other than RBO associated with EUS-HEAS with RFA. RESULTS: The technical and functional success rates were both 80% (16/20). The procedure was unsuccessful in a total of 4 patients due to failure to insert the RFA catheter through the fistula (2 patients) or failure to pass the RFA catheter through the stricture (2 patients). Early and late adverse events other than RBO occurred in 10% (2/20) and 13% (2/16) of subjects, respectively. The RBO rate was 25% (4/16), and the median time to RBO was 276 days. The success rate of endoscopic reintervention using hepaticoenterostomy was 100% (4/4). DISCUSSION: This preliminary study showed that EUS-HEAS with RFA achieves good results but RFA catheter insertion can be difficult. Further evaluation and device improvements are warranted.Keywords
This publication has 17 references indexed in Scilit:
- Endobiliary radiofrequency ablation combined with bilateral metal stent placement for malignant hilar biliary obstructionEndoscopy, 2020
- Novel balloon catheter‐based endobiliary radiofrequency ablation system: Ex‐vivo experimental studyDigestive Endoscopy, 2020
- Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography‐guided biliary drainage: 2018Journal of Hepato-Biliary-Pancreatic Sciences, 2019
- EUS-guided antegrade proceduresEndoscopic Ultrasound, 2019
- Endoscopic radiofrequency biliary ablation treatment: A comprehensive reviewDigestive Endoscopy, 2018
- EUS-Guided Antegrade Biliary Stenting Using a Novel Fully Covered Metal Stent (with Video)Journal of Gastrointestinal Surgery, 2018
- Antegrade radiofrequency ablation and stenting for biliary stricture through endoscopic ultrasound‐guided hepaticogastrostomyDigestive Endoscopy, 2018
- Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panelGut, 2018
- Utility of Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting for Malignant Biliary Obstruction after Failed Endoscopic Retrograde CholangiopancreatographyOncology, 2017
- A newly designed plastic stent for EUS-guided hepaticogastrostomy: a prospective preliminary feasibility study (with videos)Gastrointestinal Endoscopy, 2015