Endoscopic radiofrequency ablation for malignant biliary obstruction

Table 3 Controlled recurrent biliary obstruction studies

Ref.	Number of patients	Etiology	Type of study design	Case control analysis	Method	RFA device	Aim	Results
Sharaiha et al[27]	66 (26 RFA)	CCC (n = 37) PC (n = 29)	Retrospective case control study	Yes	ERFA before stenting (26pts) vs stenting alone (40 pts)	Habib EndoHPB	Survival; Stent patency; Adverse events (AE)	(1) The median survival was 5.9 mo in both groups; (2) SEMS patency rates were equivalent; (3) No differences in AE (2 RFA vs 3 no-RFA)
Strand et al[29]	48 (16 RFA)	CCC	Retrospective case control study	Yes	ERFA (16 pts) vs PDT (32)	Habib EndoHPB	Survival, stent occlusion	(1) Median survival of 9.6 mo in RFA vs 7.5 mo in PDT group; (2) RFA group more frequent stent occlusion (0.06 vs 0.02, P = 0.008) and cholangitis (0.13 vs 0.05, P = 0.008)
Kallis et al[35]	69 (23 RFA)	PC	Retrospective case control study	Yes	ERFA before stenting (23 pts) vs stenting alone (46 pts)	Habib EndoHPB	Survival, stent patency	(1) Survival time in RFA group 226 vs 123.5 da in controls (P < 0.01); (2) SEMS patency rate equivalent in both group
Liang et al[31]	76 (34 RFA)	CCC	Retrospective case control study	Yes	ERFA before stenting (34 pts) vs stenting alone (42 pts)	Habib EndoHPB	Survival, stent patency, adverse events	(1) The median survival in the ERFA + SEMS group was significantly better vs SEMS only (P = 0.036); (2) ERFA+ SEMS patency rate 9.5 mo vs 8.4 mo; (P = 0.024); (3) AE equivalent
Sampath et al[51]	25 (10 RFA)	CCC	Retrospective case control study	Yes	ERFA before stenting (10 pts) vs stenting alone (15 pts)	Habib EndoHPB	Survival	(1) Median survival 404 d vs 228 d in controls. (P < 0.001)
Schmidt et al[30]	34 (14 RFA)	CCC	Retrospective case control study	Yes	Repeated ERFA (14 pts) vs repeated PDT (20)	Habib EndoHPB	Bilirubin levem Advere events,	(1) PDT group no significant decrease (P = 0.67) vs in RFA significant decrease (P = 0.046); (2) AE more frequently in PDT (n = 8; 40%) than with RFA (n=3; 14.21%) (P = 0.277).
Bokemayer et al[33]	54 (32 RFA)	CCC (n = 45 + 1 intrahepatic); PC (n = 2); GB (n = 2); Other (n = 4)	Retrospective case control study	Yes	ERFA before stenting (32 pts) vs stenting alone (22 pts)	Habib EndoHPB	Survival	(1) Survival time in RFA group 342 ± 57 vs 221 ± 26 d in controls; (P = 0.046)
Yang et al[32]	65 (32 RFA)	CC	Randomised controlled trial	Yes	ERFA before stenting (32 pts) vs stenting alone (33 pts)	Habib EndoHPB	Overall survival, stent patency; post-ERCP AE	(1) ERFA + stent vs the stent only (13.2 ± 0.6 vs 8.3 ± 0.5 mo, P < 0.001); (2) Stent patency (6.8 vs 3.4 mo, P = 0.02); (3) Similar AE 6.3% vs 9.1%, (P = 0.67)

RFA: Recurrent biliary obstruction; CCC: Cholangiocarcinoma; PC: Pancreatic cancer; GB: Gallbladder cancer; pts: Patients; AE: Adverse events; SEMS: Self-expandable metal stents.