%0 Journal Article
%T Safety and Efficacy of Radiofrequency Ablation in the Management of Unresectable Bile Duct and Pancreatic Cancer: A Novel Palliation Technique
%A Paola Figueroa-Barojas
%A Mihir R. Bakhru
%A Nagy A. Habib
%A Kristi Ellen
%A Jennifer Millman
%A Armeen Jamal-Kabani
%A Monica Gaidhane
%A Michel Kahaleh
%J Journal of Oncology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/910897
%X Objectives. Radiofrequency ablation (RFA) has replaced photodynamic therapy for premalignant and malignant lesions of the esophagus. However, there is limited experience in the bile duct. The objective of this pilot study was to assess the safety and efficacy of RFA in malignant biliary strictures. Methods: Twenty patients with unresectable malignant biliary strictures underwent RFA with stenting between June 2010 and July 2012. Diameters of the stricture before and after RFA, immediate and 30 day complications and stent patency were recorded prospectively. Results. A total of 25 strictures were treated. Mean stricture length treated was 15.2ˋmm (SD = 8.7ˋmm, Range = 3.5每33ˋmm). Mean stricture diameter before RFA was 1.7ˋmm (SD = 0.9ˋmm, Range = 0.5每3.4ˋmm) while the mean diameter after RFA was 5.2ˋmm (SD = 2ˋmm, Range = 2.6每9ˋmm). There was a significant increase of 3.5ˋmm (t = 10.8, DF = 24, P value = <.0001) in the bile duct diameter post RFA. Five patients presented with pain after the procedure, but only one developed mild post-ERCP pancreatitis and cholecystitis. Conclusions: Radiofrequency ablation can be a safe palliation option for unresectable malignant biliary strictures. A multicenter randomized controlled trial is required to confirm the long term benefits of RFA and stenting compared to stenting alone. 1. Introduction Self-expanding metal stents (SEMS) have become the mainstay palliative treatment for malignant biliary obstruction in patients with a life expectancy greater than 3 months [1, 2]. Their use has improved bile duct patency beyond what was achieved with plastic stents; however, long-term patency continues to be an unresolved issue. SEMS can occlude from tissue ingrowth or overgrowth, benign epithelial hyperplasia or secondary to biofilm, and sludge formation within the lumen of the stent [3]. Up to 50% of patients will have stent occlusion in the first 6 to 8 months [4, 5]. Different design alternatives have been explored in an attempt to improve stent patency. Covered SEMS were designed to prevent tissue ingrowth; however, they are contra-indicated for hilar drainage, have higher migration rates, and might be associated with increased risks of pancreatitis and cholecystitis [6每11]. Another treatment strategy to prolong stent patency and eventual survival is photodynamic therapy (PDT). PDT showed promising results; however, it carries a high complication rate including cholangitis and photosensitivity requiring the patient to avoid direct exposure to light for 4每6 weeks [12每14]. Radiofrequency ablation (RFA) has been used for
%U http://www.hindawi.com/journals/jo/2013/910897/