title: Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications.
abstract: BACKGROUND
  Biliary radiofrequency ablation (RFA) using the Habib™ EndoHBP catheter is a new endoscopic palliation therapy for malignant biliary obstruction. The aim of this study was to assess the feasibility and safety of this technique.
  
  
  METHODS
  In this nationwide retrospective study of prospectively collected clinical data, all patients treated by biliary RFA in Austria between November 2010 and December 2012 were included. Procedure-related complications, adverse events within 30 days post-intervention, stent patency, and mortality rates were investigated.
  
  
  RESULTS
  A total of 58 patients (31 male, 27 female, median age 75 years) underwent 84 RFA procedures at 11 Austrian referral centers for biliary endoscopy. The predominant underlying condition was Klatskin tumor (45 of 58 cases). All 84 RFA procedures were feasible without technical problems. A partial liver infarction was induced by RFA in a 49-year-old Klatskin tumor patient. During 30 days after each RFA procedure, five cases of cholangitis, three cases of hemobilia, two cases of cholangiosepsis, and one case each of gallbladder empyema, hepatic coma, and newly diagnosed left bundle branch block occurred. Median stent patency after last electively performed RFA was 170 days (95 % CI 63-277) and was almost significantly different between metal and plastic stenting (218 vs. 115 days; p = 0.051). Median survival was 10.6 months (95 % CI 6.9-14.4) from the time of the first RFA in each patient and 17.9 months (95 % CI 10.3-25.6) from the time of initial diagnosis.
  
  
  CONCLUSIONS
  Except for one severe interventional complication (hepatic infarct), RFA presented as a technically feasible and safe therapeutic option for the palliative treatment of malignant biliary obstruction. The good results of stent patency and survival in this study should be proven in prospective (controlled) trials to further quantify the efficacy of this promising new technique.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria, werner.dolak@meduniwien.ac.at.
authors.forename: Werner
authors.initials: W
authors.lastname: Dolak
authors.forename: Florian
authors.initials: F
authors.lastname: Schreiber
authors.forename: Hubert
authors.initials: H
authors.lastname: Schwaighofer
authors.forename: Michael
authors.initials: M
authors.lastname: Gschwantler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Plieschnegger
authors.forename: Alexander
authors.initials: A
authors.lastname: Ziachehabi
authors.forename: Andreas
authors.initials: A
authors.lastname: Mayer
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kramer
authors.forename: Andreas
authors.initials: A
authors.lastname: Kopecky
authors.forename: Christiane
authors.initials: C
authors.lastname: Schrutka-Kölbl
authors.forename: Gernot
authors.initials: G
authors.lastname: Wolkersdörfer
authors.forename: Christian
authors.initials: C
authors.lastname: Madl
authors.forename: Frieder
authors.initials: F
authors.lastname: Berr
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.forename: Andreas
authors.initials: A
authors.lastname: Püspök
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001317:Austria / Q000453:epidemiology; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis; D017115:Catheter Ablation / Q000295:instrumentation*; D002415:Cats; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors