title: Radiofrequency ablation for management of malignant biliary obstruction: a single-center experience and review of the literature.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) causes coagulative necrosis of tissue and may be beneficial prior to biliary stenting. We report our experience using RFA for malignant biliary obstruction and review the literature.
  
  
  METHODS
  Retrospective analysis of all patients undergoing RFA for malignant biliary obstruction over the last two years. Success, complications and re-intervention following RFA were assessed. Controls were age, sex and disease matched who had stenting alone.
  
  
  RESULTS
  31 patients were included and 15 patients underwent biliary RFA prior to stenting (median age 78 years, 8 females). 14 patients had pancreatic cancer, 13 cholangiocarcinoma (6 hilar lesions) and 4 malignant disease invading the bile duct. Adverse events included acute pancreatitis (n = 2) and bacteremia in (n = 1). Median duration of intervention free survival was 220 days in the RFA group compared to 106.5 days in controls (hazard ratio 2.4, 95% CI 1.1 - 5.3, p = 0.025). Multivariable Cox proportional hazard analysis showed survival was associated with RFA (hazard ratio 2.55, 95% CI 1.09-5.96, p = 0.026) but not age, site or type of malignancy.
  
  
  CONCLUSIONS
  Biliary RFA is a technically feasible with a low adverse event rate and is associated with increased survival. Multi-centre randomized controlled trials are required.
authors.affiliation: a Department of Gastroenterology , Aberdeen Royal Infirmary , Foresterhill Road, Aberdeen , UK.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Dutta
authors.affiliation: a Department of Gastroenterology , Aberdeen Royal Infirmary , Foresterhill Road, Aberdeen , UK.
authors.forename: Umesh
authors.initials: U
authors.lastname: Basavaraju
authors.affiliation: a Department of Gastroenterology , Aberdeen Royal Infirmary , Foresterhill Road, Aberdeen , UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Sales
authors.affiliation: a Department of Gastroenterology , Aberdeen Royal Infirmary , Foresterhill Road, Aberdeen , UK.
authors.forename: John Samuel
authors.initials: JS
authors.lastname: Leeds
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Radiofrequency ablation; adverse events; cholangiocarcinoma; pancreatic carcinoma; survival