Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2023; 15(3): 177-190
Published online Mar 16, 2023. doi: 10.4253/wjge.v15.i3.177
Endoscopic biliary treatment of unresectable cholangiocarcinoma: A meta-analysis of survival outcomes and systematic review
Jeffrey Rebhun, Claire M Shin, Uzma D Siddiqui, Edward Villa
Jeffrey Rebhun, Department of Gastroenterology, Oregon Health and Sciences University, Portland, OR 97239, United States
Claire M Shin, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, United States
Uzma D Siddiqui, Center for Endoscopic Research and Therapeutics, University of Chicago, University of Chicago Medicine, Chicago, IL 60637, United States
Edward Villa, Department of Gastroenterology and Hepatology, Northshore University Health System, Evanston, IL 60201, United States
Author contributions: Villa E contributed to conception and design; Rebhun J and Villa E contributed to analysis and interpretation of the data; Rebhun J, Shin CM, Villa E contributed to drafting of the article; Siddiqui UD and Villa E contributed to critical revision of the article for important intellectual content; Rebhun J, Shin CM, Siddiqui UD, Villa E contributed to final approval of the article.
Conflict-of-interest statement: Uzma Siddiqui has served as a speaker/consultant for Boston Scientific, Medtronic, and Olympus. Edward Villa has served as a consultant/speaker for ConMed as well as a speaker for Ovesco.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jeffrey Rebhun, MD, Academic Fellow, Department of Gastroenterology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. jeffrebhun@gmail.com
Received: November 3, 2022
Peer-review started: November 3, 2022
First decision: December 11, 2022
Revised: January 12, 2023
Accepted: March 1, 2023
Article in press: March 1, 2023
Published online: March 16, 2023
Processing time: 132 Days and 9.9 Hours
Abstract
BACKGROUND

Endoscopic radiofrequency ablation (ERFA), percutaneous radiofrequency ablation (PRFA), and photodynamic therapy (PDT), when used in conjunction with conventional biliary stenting, have demonstrated a survival benefit in patients with unresectable cholangiocarcinoma.

AIM

To compare pooled survival outcomes, adverse event rates, and mean stent patency for those undergoing these procedures.

METHODS

A comprehensive literature review of published studies and abstracts from January 2011 to December 2020 was performed comparing survival outcomes in patients undergoing ERFA with stenting, biliary stenting alone, PRFA with stenting, and PDT with stenting for unresectable cholangiocarcinoma (CCA).

RESULTS

Data from four studies demonstrated a pooled mean survival favoring ERFA as compared to biliary stenting alone (12.0 ± 0.9 mo vs 6.8 ± 0.3 mo, P < 0.001) as well as statistically improved median survival time (13 mo vs 8 mo, P < 0.001). Both ERFA with stenting and PRFA with stenting groups demonstrated statistical superiority to biliary stenting alone (P < 0.001 and P = 0.004, respectively). However, when comparing ERFA to PRFA, pooled data demonstrated overall higher mean survival in the ERFA with stenting cohort as compared to PRFA with stent cohort (12.0 + 0.9 mo vs 8.1 + 2.1 mo, P < 0.0001). Data from two studies demonstrated a pooled median survival favoring ERFA with stenting as compared to PDT with stenting (11.3 mo vs 8.5 mo, P = 0.02).

CONCLUSION

While further prospective, randomized studies are needed to assess efficacy of ERFA, our meta-analysis demonstrated that this technique offers endoscopists a reasonable palliative method by which to treat patients with unresectable CCA that results in longer survival as compared to biliary stenting alone, percutaneous radiofrequency ablation with biliary stenting, and PDT with biliary stenting as well as an acceptable adverse event profile based on available published data.

Keywords: Endoscopic radiofrequency ablation, Percutaneous radiofrequency ablation, Photodynamic therapy, Cholangiocarcinoma, Meta-analysis, Systematic review

Core Tip: Endoscopic radiofrequency ablation offers endoscopists a reasonable palliative method by which to treat patients with unresectable cholangiocarcinoma that results in longer survival as compared to biliary stenting alone, percutaneous radiofrequency ablation, with biliary stenting, and photodynamic therapy with biliary stenting.