Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2021; 13(10): 1383-1396
Published online Oct 15, 2021. doi: 10.4251/wjgo.v13.i10.1383
Endoscopic radiofrequency ablation for malignant biliary obstruction
Jana Jarosova, Peter Macinga, Alzbeta Hujova, Jan Kral, Ondrej Urban, Julius Spicak, Tomas Hucl
Jana Jarosova, Peter Macinga, Alzbeta Hujova, Jan Kral, Julius Spicak, Tomas Hucl, Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Praha 14021, Czech Republic
Ondrej Urban, Department of Internal Medicine II – Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentristry, Palacky University Olomouc, Olomouc 77900, Czech Republic
Author contributions: Jarosova J and Hucl T performed the majority of the writing; Jarosova J prepared all the figures and tables; Macinga P, Hujova A, Kral J, Urban O performed data interpretation and writing; Spicak J provided major guidance in writing the paper and revised it; Hucl T coordinating the writing of the paper.
Supported by The Czech Grant Research Council, No. 17-30281A.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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:
Corresponding author: Tomas Hucl, MD, Doctor, Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Videnska 9, Praha 14021, Czech Republic.
Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: June 4, 2021
Revised: June 17, 2021
Accepted: August 24, 2021
Article in press: August 24, 2021
Published online: October 15, 2021

Cholangiocarcinoma and pancreatic cancer are the most common causes of malignant biliary obstruction. The majority of patients are diagnosed at a late stage when surgical resection is rarely possible. In these cases, palliative chemotherapy and radiotherapy provide only limited benefit and are associated with poor survival. Radiofrequency ablation (RFA) is a procedure for locoregional control of tumours, whereby a high-frequency alternating current turned into thermal energy causes coagulative necrosis of the tissue surrounding the catheter. The subsequent release of debris and tumour antigens by necrotic cells can stimulate local and systemic immunity. The development of endoluminal RFA catheters has led to the emergence of endoscopically delivered RFA, a treatment mainly used for malignant biliary strictures to prolong survival and/or stent patency. Other indications include recanalisation of occluded biliary stents and treatment of intraductal ampullary adenoma or benign biliary strictures. This article presents a comprehensive review of endobiliary RFA, mainly focusing on its use in patients with malignant biliary obstruction. The available data suggest that biliary RFA may be a promising modality, having positive impacts on survival and stent patency and boasting a reasonable safety profile. However, further studies with better characterised and stratified patient populations are needed before the method becomes accepted within routine clinical practice.

Keywords: Radiofrequency, Ablation, Biliary, Stenosis, Cholangiocarcinoma, Pancreatic cancer

Core Tip: Cholangiocarcinoma and pancreatic cancer are typically diagnosed at a late stage with poor prognosis. These conditions often cause biliary obstruction, which can be targeted by endoluminal radiofrequency ablation. Induced heat results in coagulative necrosis and the release of tumour antigens, in turn activating the systemic immune response. This review presents the available evidence for biliary radiofreqency ablation efficiency and safety. Although some of the data indicate positive impacts on survival and stent patency, further studies incorporating better defined patient populations and randomised settings are needed to confirm these promising results.