Malign Safra Yolu Darlıklarında Perkütan Endobiliyer Radyofrekans Ablasyonun Etkisi

Year 2023, Volume: 25 Issue: 1, 78 - 84, 30.04.2023

Hamza Özer , Bige Sayın , İlkay Akmangit

https://doi.org/10.18678/dtfd.1218573

Abstract

Amaç: Bu çalışmanın amacı, malign biliyer darlıklarda stent açıklığını artırmak için kullanılan perkütan endobiliyer radyofrekans ablasyon (endobiliary radiofrequency ablation, ERFA) yönteminin uygulanabilirliğini ortaya koymaktır.
Gereç ve Yöntemler: Çeşitli ilerlemiş tümörlere sekonder malign biliyer stenoz gelişen ve perkütan biliyer drenaj sonrası ERFA ve metalik stent uygulanan 9 (36%) kadın ve 16 (64%) erkek olmak üzere toplam 25 hasta geriye dönük olarak değerlendirildi. Hastaların ortanca sağkalım ve stent açıklığı değerlerinin gösterilmesi için obstruksiyona sebep olan malignitelerin türleri ile işlem sonrası takipleri değerlendirildi. Stent açıklığı ve sağkalım oranları Kaplan-Meier yöntemi kullanılarak hesaplandı.
Bulgular: Bu çalışmaya dahil edilen 25 hastadan 17'si (%68) işlem sonrası ilk hafta bilirubin değerlerinde pre-biliyer drenaj değerlerine göre %50'den fazla azalma ile anlamlı bir düşüş gösterdi. Bu tedavi yaklaşımının genel klinik başarı oranı %68 olarak tespit edildi. ERFA ve metalik stent uygulanan 25 hastanın 8'inde (%32) 180 gün içinde stent tıkanıklığı gelişti. Ayrıca 18 (%72) hasta malignite progresyonu sonucu hayatını kaybetti. Tedavi sonrası 30 ve 180 gündeki ölüm oranları sırasıyla %24 ve %72 olarak belirlendi. Ortanca hayatta kalma ve stent açık kalma süreleri sırasıyla 65 ve 70 gündü.
Sonuç: Perkütan ERFA ve metalik stentleme, özellikle distal biliyer stenozu olan seçilmiş hasta gruplarında sağkalımı ve stent açıklığını iyileştirme potansiyeline sahiptir. Bu sonuçları doğrulamak için randomize kontrollü çalışmalara ihtiyaç vardır.

Keywords

Malign Biliyer Darlık, Perkütan endobiliyer radyofrekans ablasyon, biliyer drenaj, biliyer stent

Effect of Percutaneous Endobiliary Radiofrequency Ablation in Malignant Bile Stenosis

Abstract

Aim: This study aimed to demonstrate the feasibility of the percutaneous endobiliary radiofrequency ablation (ERFA) method, which is used to increase stent patency in malignant biliary strictures.
Material and Methods: A total of 25 patients, 9 (36%) female and 16 (64%) male, who developed malignant biliary stenosis secondary to various advanced tumors and underwent ERFA and metallic stenting after percutaneous biliary drainage were retrospectively evaluated. The types of malignancies causing obstruction and the follow-up after the procedure were evaluated to demonstrate the median survival and stent patency values of the patients. Stent patency and survival rates were calculated using the Kaplan-Meier method.
Results: The results of the study demonstrated that 17 (68%) out of these 25 patients displayed a significant decrease in their first-week postoperative bilirubin values, with a reduction of greater than 50% compared to the pre-biliary drainage values. The study determined that this treatment approach's overall clinical success rate was 68%. Stent occlusion developed within 180 days in 8 (32%) out of the 25 patients who underwent ERFA and metallic stenting. Additionally, 18 (%72) patients died as a result of malignancy progression. The mortality rates at post-treatment 30 and 180 days were determined to be 24% and 72%, respectively. The median survival and stent patency times were 65 and 70 days, respectively.
Conclusion: Percutaneous ERFA and metallic stenting have the potential to improve survival and stent patency, especially in selected patient groups with distal biliary stenosis. Randomized controlled studies are needed to confirm these results.

Keywords

Malignant biliary obstruction, Percutaneous endobiliary radiofrequency ablation, Biliary drainage, Biliary stenting

References

• Lammer J, Hausegger KA, Flückiger F, Winkelbauer FW, Wildling R, Klein GE, et al. Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology. 1996;201(1):167-72.
• Lorenz JM. Management of malignant biliary obstruction. Semin Intervent Radiol. 2016;33(4):259-68.
• Nam HS, Kang DH. Current status of biliary metal stents. Clin Endosc. 2016;49(2):124-30.
• Park JS, Jeong S, Lee DH. Recent advances in gastrointestinal stent development. Clin Endosc. 2015;48(3):209-15.
• Mizandari M, Kumar J, Pai M, Chikovani T, Azrumelashvili T, Reccia I, et al. Interventional radiofrequency ablation: A promising therapeutic modality in the management of malignant biliary and pancreatic duct obstruction. J Cancer. 2018;9(4):629-37.
• Mizandari M, Pai M, Xi F, Valek V, Tomas A, Quaretti P, et al. Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol. 2013;36(3):814-9.
• Lee YN, Jeong S, Choi HJ, Cho JH, Cheon YK, Park SW, et al. The safety of newly developed automatic temperature-controlled endobiliary radiofrequency ablation system for malignant biliary strictures: A prospective multicenter study. J Gastroenterol Hepatol. 2019;34(8):1454-9.
• Khizar H, Hu Y, Wu Y, Ali K, Iqbal J, Zulqarnain M, et al. Efficacy and safety of radiofrequency ablation plus stent versus stent-alone treatments for malignant biliary strictures: A systematic review and meta-analysis. J Clin Gastroenterol. 2023;57(4):335-45.
• Acu B, Kurtulus Ozturk E. Feasibility and safety of percutaneous transhepatic endobiliary radiofrequency ablation as an adjunct to biliary stenting in malignant biliary obstruction. Diagn Interv Imaging. 2018;99(4):237-45.
• Wu TT, Li HC, Li WM, Ao GK, Lin H, Zheng F, et al. Percutaneous intraluminal radiofrequency ablation for malignant extrahepatic biliary obstruction: a safe and feasible method. Dig Dis Sci. 2015;60(7):2158-63.
• Zhou C, Wei B, Gao K, and Zhai R. Biliary tract perforation following percutaneous endobiliary radiofrequency ablation: A report of two cases. Oncol Lett. 2016;11(6):3813-6.
• Akinci D, Unal E, Ciftci TT, Kyendyebai S, Abbasoglu O, Akhan O. Endobiliary radiofrequency ablation in the percutaneous management of refractory benign bilioenteric anastomosis strictures. AJR Am J Roentgenol. 2019;212(3):W83-W91.
• Li TF, Huang GH, Li Z, Hao CF, Ren JZ, Duan XH, et al. Percutaneous transhepatic cholangiography and intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction. J Vasc Interv Radiol. 2015;26(5):715-21.
• Uyanık SA, Öğüşlü U, Çevik H, Atlı E, Yılmaz B, Gümüş B. Percutaneous endobiliary ablation of malignant biliary strictures with a novel temperature-controlled radiofrequency ablation device. Diagn Interv Radiol. 2021;27(1):102-8.
• Cui W, Wang Y, Fan W, Lu M, Zhang Y, Yao W, et al. Comparison of intraluminal radiofrequency ablation and stents vs. stents alone in the management of malignant biliary obstruction. Int J Hyperthermia. 2017;33(7):853-61.
• Kallis Y, Phillips N, Steel A, Kaltsidis H, Vlavianos P, Habib N, et al. Analysis of endoscopic radiofrequency ablation of biliary malignant strictures in pancreatic cancer suggests potential survival benefit. Dig Dis Sci. 2015;60(11):3449-55.
• Kong YL, Zhang HY, Liu CL, He XJ, Zhao G, Wang C, et al. Improving biliary stent patency for malignant obstructive jaundice using endobiliary radiofrequency ablation: experience in 150 patients. Surg Endosc. 2022;36(3):1789-98.
• Oh D, Chong J, Song TJ, Park DH, Lee SS, Seo DW, et al. The usefulness of endobiliary radiofrequency ablation before metal stent placement in unresectable malignant hilar obstruction. J Gastroenterol Hepatol. 2022;37(11):2083-90.