Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Endobiliary Radiofrequency Ablation in Malignant Biliary Strictures: Nonrandomized Prospective Cohort Study
Malign Biliyer Darlıklarda Endobiliyer Radyofrekans Ablasyon: Nonrandomize Prospektif Kohort Çalışması
Gülşah YILDIRIMa, Hakkı Muammer KARAKAŞa
aDepartment of Radiology, University of Health Sciences İstanbul Fatih Sultan Mehmet Training and Research Hospital, İstanbul, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(3):280-8
doi: 10.5336/medsci.2021-81408
Article Language: EN
Full Text
ABSTRACT
 Objective: Self-expandable metallic stents are superior to establish and preserve biliary drainage in malignant biliary obstructions. Endobiliary radiofrequency ablation (EB-RFA) is an important adjunct to increase the efficacy and length of the stent patency. This study is on the efficacy and safety of transhepatic EB-RFA and discusses its procedural steps and technical tips for successful implementation. Material and Methods: Clinical and imaging data of eight patients were retrospectively analyzed. The intervention included EBRFA, stenting, balloon dilatation and temporary internal biliary catheterization of previously untreated cases. The technical efficacy was determined as the percentage of successfully catheterized patients. The short-term clinical efficacy was determined as the comparison of pre- and post-procedural total and direct bilirubin levels. Results: The mean pre-ablation luminal diameter was 2.4±0.7 mm and the mean post-ablation luminal diameter 7.8±2.0 mm. No intraprocedural and 30-day mortality was encountered. Multiple hepatic abscesses developed in a patient who had re-ablation and two others experienced cholangitis. The most common minor complication was abdominal pain. The preprocedural total bilirubin level was 8.39±3.45 and the direct bilirubin level was 6.82±3.11. The postprocedural total bilirubin level at 7th day was 4.10±2.85 and direct bilirubin level was 2.96±2.16. Patients were followed up to 6.5 months after the procedure. The mean patency time was 56 days and the mean survival was 122 days. Conclusion: This study supports previous reports on EB-RFA and shows the safety and the efficacy of the technique and its implementation. Keeping all procedural steps and possible complications in mind, it has a relatively short learning curve.

Keywords: Endobiliary radiofrequency ablation; malign biliary obstruction; stent; impedance
ÖZET
 Amaç: Malign safra yolu darlıklarında, kendi kendine genişleyen metalik stentler biliyer drenajın sağlanmasında ve korunmasında kullanılmaktadır. Endobiliyer radyofrekans ablasyon (EB-RFA) stent açıklığının sağlanmasında ve patens süresinin uzatılmasında önemli bir yardımcıdır. Çalışmanın amacı, transhepatik EB-RFA'nın etkinliği ve güvenliğini göstermek, başarılı uygulama için prosedür adımlarını ve teknik ipuçlarını paylaşmaktır. Gereç ve Yöntemler: Maligniteye bağlı biliyer darlığı bulunan 8 hasta retrospektif olarak incelendi. İşlem basamakları; EB-RFA, stentleme, balon dilatasyon ve daha önce tedavi edilmemiş olguların geçici internal safra kateterizasyonunu içermektedir. Teknik etkinlik, başarılı bir şekilde kateterize edilmiş hastaların yüzdesi olarak belirlendi. Kısa süreli klinik etkinlik ise işlem öncesi ve sonrası total ve direkt bilurubin değerlerinin karşılaştırılmasıyla değerlendirildi. Bulgular: Ablasyon öncesi ortalama lümen çapı 2,4±0,7 mm ve ablasyon sonrası ortalama lümen çapı 7,8±2,0 mm idi. Prosedür sırasında ve sonrasındaki 30 günde mortalite izlenmedi. İki hastada işleme bağlı kolanjit gelişti ve birinde 2. ablasyon sonrası çok sayıda hepatik apse izlendi. İşlem öncesi total bilurubin düzeyi 8,39±3,45 ve direkt bilurubin düzeyi 6,82±3,11 idi. İşlem sonrası 7. günde ise sırasıyla 4,10±2,85 ve 2,96±2,16 olarak ölçüldü. Hastalar işlemden sonra 6,5 aya kadar takip edildi. Ortalama stent patensi 56 gün ve ortalama sağkalım 122 gündü. Sonuç: Bu çalışma, literatürdeki diğer EB-RFA çalışmalarını destekler nitelikte olup, tekniğin ve uygulamasının güvenilir ve etkili olduğunu göstermektedir. Tüm prosedür adımlarını ve olası komplikasyonları göz önünde bulundurarak nispeten kısa bir öğrenme eğrisine sahiptir.

Anahtar Kelimeler: Endobiliyer radyofrekans ablasyon; malign biliyer darlık; stent; empedans
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