Published online Jun 16, 2023. doi: 10.4253/wjge.v15.i6.440
Peer-review started: December 27, 2022
First decision: January 17, 2023
Revised: February 15, 2023
Accepted: May 12, 2023
Article in press: May 12, 2023
Published online: June 16, 2023
Processing time: 168 Days and 20 Hours
Recently, endoscopic intraductal radiofrequency ablation (ID-RFA) has attracted attention as a local treatment method for malignant biliary obstruction (MBO). ID-RFA causes coagulative necrosis of the tumor tissue in the stricture and induces exfoliation. Its effects are expected to extend the patency period of biliary stents and prolong the survival period. Evidence for extrahepatic cholangiocarcinoma (eCCA) is gradually accumulating, and some reports show significant therapeutic effects in eCCA patients without distant metastasis. However, it is still far from an established treatment technique, and many unsolved problems remain. Therefore, when performing ID-RFA in clinical practice, it is necessary to understand and grasp the current evidence well and to operate appropriately for the true benefit of the patients. This paper reviews the current status, issues, and prospects of endoscopic ID-RFA for MBO, especially for eCCA.
Core Tip: Intraductal radiofrequency ablation can be a useful option as a local therapy for malignant biliary obstruction, but there are still many unclear points. Although increasing reports suggest its usefulness, mainly for extrahepatic cholangiocarcinoma without distant metastasis, it is still far from being a standard treatment. Additionally, it should be recognized that the currently available ablation catheter could not always provide sufficient ablation in all cases. In addition to accumulating further evidence, it is necessary to establish its usefulness, clarify its indication, and develop an innovative device that can perform appropriate ablation for all lesions.