title: Analysis of Endoscopic Radiofrequency Ablation of Biliary Malignant Strictures in Pancreatic Cancer Suggests Potential Survival Benefit.
abstract: BACKGROUND
  Pancreatic carcinoma is often inoperable, carries a poor prognosis, and is commonly complicated by malignant biliary obstruction. Phase I/II studies have demonstrated good safety and early stent patency using endoscopic biliary radiofrequency ablation (RFA) as an adjunct to self-expanding metal stent (SEMS) insertion for biliary decompression.
  
  
  OBJECTIVE
  To analyze the clinical efficacy of endobiliary RFA.
  
  
  METHODS
  Retrospective case-control analysis was carried out for 23 patients with surgically unresectable pancreatic carcinoma and malignant biliary obstruction undergoing endoscopic RFA and SEMS insertion and 46 controls (SEMS insertion alone) in a single tertiary care center. Controls were stringently matched for age, sex, metastases, ASA/comorbidities. Survival, morbidity, and stent patency rates were assessed.
  
  
  RESULTS
  RFA and control groups were closely matched-ASA 2.35 ± 0.65 versus 2.54 ± 0.50, p = 0.086; metastases 9/23 (39.1%) versus 18/46 (39.1%), p = 0.800; chemotherapy 16/23 (69.6%) versus 24/46 (52.2%), p = 0.203. Median survival in RFA group was 226 days (IQR 140-526 days) versus 123.5 days (IQR 44-328 days) in controls (p = 0.010). RFA was independently predictive of survival at 90 days (OR 21.07, 95% CI 1.45-306.64, p = 0.026) and 180 days (OR 4.48, 95% CI 1.04-19.30, p = 0.044) in multivariate analysis. SEMS patency rates were equivalent in both groups. RFA was well tolerated with minimal side effects.
  
  
  CONCLUSIONS
  Endoscopic RFA is a safe and efficacious adjunctive treatment in patients with advanced pancreatic malignancy and biliary obstruction and may confer early survival benefit. Randomized prospective clinical trials of this new modality are mandated.
authors.affiliation: HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. yiannis.kallis@nhs.net.
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Kallis
authors.affiliation: HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. natalie.phillips@imperial.nhs.uk.
authors.forename: Natalie
authors.initials: N
authors.lastname: Phillips
authors.affiliation: Department of Gastroenterology, Chelsea and Westminster Hospital NHS Trust, London, UK. alan.steel@chelwest.nhs.uk.
authors.forename: Alan
authors.initials: A
authors.lastname: Steel
authors.affiliation: HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. harry.kaltsidis@nhs.net.
authors.forename: Harry
authors.initials: H
authors.lastname: Kaltsidis
authors.affiliation: HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. panagiotis.vlavianos@imperial.nhs.uk.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Vlavianos
authors.affiliation: Academic Department of Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. nagy.habib@imperial.nhs.uk.
authors.forename: Nagy
authors.initials: N
authors.lastname: Habib
authors.affiliation: HPB Unit/Department of Gastroenterology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK. david.westaby@imperial.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Westaby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Biliary metal stent; Malignant biliary stricture; Obstructive jaundice; Therapeutic endoscopy