Background:

Malignant biliary stricture usually presents as unresectable disease. These patients require endoscopic stent placement for biliary drainage. Endoscopic radiofrequency ablation is an adjuvant therapy for these patients. Comparing patients underwent radiofrequency ablation plus endoscopic stent placement have longer stent patency (3.4 vs. 6.8 months) and mainly improve survival (13.2 vs. 8.3 months) against patients with biliary stent alone, without increase adverse events.

Objectives:

To compare patient survival, clinical success, stent patency and procedure-related adverse events between patients with unresectable malignant biliary strictures who received endoscopic drainage biliary tract plus radiofrequency ablation against a control group with endoscopic drainage only.

Methods:

This was a single center, comparative, prospective study. We followed patients with unresectable malignant biliary stricture by cholangiocarcinoma, pancreatic cancer and ampulloma, who underwent endoscopic biliary drainage in National Institute of Cancerology from January 2014 to May 2019; we compared patients who also were treated with endoscopic radiofrequency ablation with patients who underwent endoscopic stent alone. Diagnosis, type of stenosis, stent type, functionality and chemotherapy were analyzed. The primary outcome was survival, secondary outcomes were clinical success, stent patency and adverse events.

Results:

40 patients with unresectable malignant biliary strictures who were underwent endoscopic stent placement were included. 62% (25) cholangiocarcinoma, 20% (8) pancreatic cancer and 17.5% (7) with ampulloma. Mainly women 62.5%, average age 60 years old. The majority were placed metal stent 65% (26) and 35% (14) with plastic stent. 62 % (25) were treated with palliative chemotherapy. There were no statistically significant differences between the baseline features of both groups. A Kaplan Meier survival curve was performed to compare the survival since diagnosis between the two groups; a longer survival was seen in the patients who underwent radiofrequency ablation, median survival of 409 days (362 to 455 days), against a median survival of 145 days (109 to 180) in the control group with a statistically significant difference (log rank = 0.008). There was no difference in stent patency between radiofrequency ablation patients compared with control group (80 days vs 70 days, p=0.55). There was no difference in the clinical response (50% decrease of bilirubin within 7 days of procedure) between patients with radiofrequency or stent alone (63.6 vs. 73.9%, p = 0.37). About adverse events, 33% of patients who received radiofrequency had abdominal pain, while this was reported in 21.4% of control patients (p = 0.42). There weren´t other complications such as hemobilia, cholecystitis or pancreatitis.

Conclusion:

There was longer survival between patients who underwent endoscopic radiofrequency ablation compared with endoscopic stent alone, among unresectable malignant biliary stricture matched by diagnosis, functionality, stricture type, stricture length and chemotherapy; without there was an increase in the stent patency neither more complications.

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