title: Comparison of metal stenting with radiofrequency ablation versus stenting alone for treating malignant biliary strictures: is there an added benefit?
abstract: BACKGROUND
  Radiofrequency ablation (RFA) has been reported to be a beneficial treatment option for palliation of malignant biliary strictures. Biliary obstruction is a common complication in pancreatic and cholangiocarcinoma and many patients require stenting for definitive decompression. The objective of this study was to compare the survival duration of patients as well as safety and efficacy of RFA and metal stent versus stent alone.
  
  
  METHODS
  A prospectively established database was analyzed retrospectively and extracted 64 patients with malignant biliary strictures. Patients who underwent RFA with metal stenting were compared to those who were treated conventionally with metal stenting alone. The groups were matched on age, diagnosis, performance status, and palliative chemotherapy. Immediate and 30-day adverse events were recorded. Survival and Cox proportional hazard analyses were calculated.
  
  
  RESULTS
  RFA and control groups were closely matched in terms of age (65.5 ± 13.4 vs. 66.8 ± 12.16 years, p = 0.069) and diagnosis [cholangiocarcinoma (36) and pancreatic cancer (28)]. Technical success rate for both groups was 100 %. Multivariable Cox proportional regression analysis showed RFA to be an independent predictor of survival [HR 0.29 (0.11-0.76), p = 0.012] as well as age and receipt of chemotherapy [HR 1.04 (1.01-1.07), p = 0.011; HR 0.26 (0.10-0.70), p = 0.007]. Overall self-expanding metal stent patency rates were the same across both groups.
  
  
  CONCLUSIONS
  RFA appears to improve survival in patients with end-stage cholangiocarcinoma and pancreatic cancer. In a disease with limited treatment options, this modality may prove to be beneficial compared to stenting alone. Randomized controlled trials and evaluation of quality of life measures should be performed to confirm these findings.
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical College, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.forename: Nikola
authors.initials: N
authors.lastname: Natov
authors.forename: Kati S
authors.initials: KS
authors.lastname: Glockenberg
authors.forename: Jessica
authors.initials: J
authors.lastname: Widmer
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications; D017115:Catheter Ablation / Q000379:methods*; D002779:Cholestasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents