title: Endoscopic radiofrequency ablation may be preferable in the management of malignant biliary obstruction: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Endoscopic biliary radiofrequency ablation (RFA) has been increasingly used to treat unresectable malignant biliary obstruction (MBO). We aimed to perform this systematic review and meta-analysis to evaluate the efficacy and safety for the treatment of malignant biliary obstruction (MBO) and its impact on patient's survival.
  
  
  METHODS
  A comprehensive search of the Cochrane Library, PubMed and EMBASE databases was conducted. A meta-analysis was performed by extracting the data from the included studies with regard to technical effectiveness, overall survival, adverse events and mortality of endoscopic RFA.
  
  
  RESULTS
  A total of nine studies comprising 263 patients with MBO were included in the analysis. There was a significant increase in the diameter of stricture (3.446 mm, 95% confidence interval [CI] 3.356-3.536 mm) after the endoscopic biliary RFA. The overall survival time was 9.62 months, with pooled 30-day, 90-day and 2-year mortality rates of 2% (95% CI 0.5-5.9%), 21% (95% CI 5-37%), and 48% (95% CI 37-59%), respectively. The pooled rate of adverse events was 17% (95% CI 10-25%), and most complications were mild and managed conservatively. Severe adverse events occurred in three patients (two deaths due to hemobilia and one with partial liver infarction).
  
  
  CONCLUSIONS
  Endoscopic biliary RFA is effective and generally safe in the management of unresectable biliary malignancies, and may improve patients' overall survival. Prospective, randomized controlled studies are required to further support the results.
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Xiao
authors: X
authors: Zheng
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Zhi Yuan
authors: ZY
authors: Bo
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Wei
authors: W
authors: Wan
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Ye Chen
authors: YC
authors: Wu
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Tian Tian
authors: TT
authors: Wang
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Jun
authors: J
authors: Wu
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Dao Jian
authors: DJ
authors: Gao
authors: Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.
authors: Bing
authors: B
authors: Hu
mesh_terms: D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D004067:Digestive System Neoplasms / Q000150:complications / Q000601:surgery; D016145:Endoscopy, Digestive System; D006801:Humans; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D015607:Stents; D016019:Survival Analysis
keywords: efficacy; malignant biliary obsturction; meta-analysis; radiofrequency albation; safety