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Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non-Resectable Malignant Biliary Obstruction: A Single-Institution Experience.

Duan XH, Wang YL, Han XW, Ren JZ, Li TF, Zhang JH, Zhang K, Chen PF - PLoS ONE (2015)

Bottom Line: The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.Combination treatment was successful for all patients.Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China.

ABSTRACT

Objectives: To determine the safety and feasibility of intraductal radiofrequency ablation (RFA) followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion.

Methods: Fourteen patients with malignant biliary obstruction and blocked metal stents were studied retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were monitored clinically and radiologically. The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.

Results: Combination treatment was successful for all patients. There were no severe complications during RFA or local treatments. All patients had stent patency restored, with a decline in serum bilirubin. Three patients had recurrent jaundice by 195, 237 and 357 days; two patients underwent repeat intraductal RFA; and one required an internal-external biliary drain. The average stent patency time was 234 days (range 187-544 days). With a median follow-up of 384 days (range 187-544 days), six patients were alive, while eight had died. There was no mortality at 30 days. The 3, 6, 12 and 18 month survival rates were 100%, 100%, 64.3% and 42.9%, respectively.

Conclusion: Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

No MeSH data available.


Related in: MedlinePlus

A 73-year-old woman with a highly differentiated adenocarcinoma of the middle third of the bile duct was underwent PTCB for pathogic diagnosis, at the site of biliary obstruction due to the tumor (arrows) (a).(b). Four months after biliary stent implantation, a contrast-enhanced CT showed dilated intrahepatic biliary ducts, a narrowing of the diameter of stent at the middle bile duct, and enlargement of the size of the tumor with obvious enhancement (long arrow). (c) Preablation PTC revealed stent blockages (arrows). (d) Intraductal RFA was performed with a percutaneous RFA catheter using a 0.035 inch guide wire. The two electrodes (arrows) of the RFA catheter were positioned in the area of the occlusion. (e) A balloon catheter moved back and forth through the stent into the duodenum to remove ablated tissue and debris from the stent. (f) Post-ablation PTC revealed the obstruction has been relieved.
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pone.0134857.g001: A 73-year-old woman with a highly differentiated adenocarcinoma of the middle third of the bile duct was underwent PTCB for pathogic diagnosis, at the site of biliary obstruction due to the tumor (arrows) (a).(b). Four months after biliary stent implantation, a contrast-enhanced CT showed dilated intrahepatic biliary ducts, a narrowing of the diameter of stent at the middle bile duct, and enlargement of the size of the tumor with obvious enhancement (long arrow). (c) Preablation PTC revealed stent blockages (arrows). (d) Intraductal RFA was performed with a percutaneous RFA catheter using a 0.035 inch guide wire. The two electrodes (arrows) of the RFA catheter were positioned in the area of the occlusion. (e) A balloon catheter moved back and forth through the stent into the duodenum to remove ablated tissue and debris from the stent. (f) Post-ablation PTC revealed the obstruction has been relieved.

Mentions: All patients underwent PTC and percutaneous transhepatic cholangiography biopsy (PTCB) before stent implantation in the initial procedure. The procedure was performed by transhepatic puncture of a branch of the intrahepatic bile duct with a 21-gauge needle, under digital subtraction angiography (DSA) guidance (Artis Zeego, Siemens, Munich, Germany). PTC was then performed to visualize the location, extent and degree of bile duct obstruction using a percutaneous transhepatic cholangiography puncture set (Cook Inc., Bloomington, IN, USA). A 5 F Cobra catheter (Cook Inc.) was introduced into the bile duct with a 0.035 inch guide wire (Cook Inc.). The catheter and guide wire were passed through the stenosis simultaneously into the duodenum or jejunum. The guide wire was then replaced with a 0.035 inch stiff guide wire (Cook Inc.), and a 9 F catheter sheath was advanced along the stiff guide wire with 8 F biopsy forceps passed through the sheath. The sheath was pushed forward forcefully against the upper segment of the stenosis, while the biopsy forceps were introduced to the lesion through the introducing sheath. The PTCB was performed according to Li et al. [12] (Fig 1a). Following PTCB, an inner non-covered stent (Micro-Tech) was placed. Next, an 8.5 F internal–external biliary drainage tube (Cook Inc.) was implanted though the stent to the duodenum until the maximal decrease in serum bilirubin level was achieved.


Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non-Resectable Malignant Biliary Obstruction: A Single-Institution Experience.

Duan XH, Wang YL, Han XW, Ren JZ, Li TF, Zhang JH, Zhang K, Chen PF - PLoS ONE (2015)

A 73-year-old woman with a highly differentiated adenocarcinoma of the middle third of the bile duct was underwent PTCB for pathogic diagnosis, at the site of biliary obstruction due to the tumor (arrows) (a).(b). Four months after biliary stent implantation, a contrast-enhanced CT showed dilated intrahepatic biliary ducts, a narrowing of the diameter of stent at the middle bile duct, and enlargement of the size of the tumor with obvious enhancement (long arrow). (c) Preablation PTC revealed stent blockages (arrows). (d) Intraductal RFA was performed with a percutaneous RFA catheter using a 0.035 inch guide wire. The two electrodes (arrows) of the RFA catheter were positioned in the area of the occlusion. (e) A balloon catheter moved back and forth through the stent into the duodenum to remove ablated tissue and debris from the stent. (f) Post-ablation PTC revealed the obstruction has been relieved.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526692&req=5

pone.0134857.g001: A 73-year-old woman with a highly differentiated adenocarcinoma of the middle third of the bile duct was underwent PTCB for pathogic diagnosis, at the site of biliary obstruction due to the tumor (arrows) (a).(b). Four months after biliary stent implantation, a contrast-enhanced CT showed dilated intrahepatic biliary ducts, a narrowing of the diameter of stent at the middle bile duct, and enlargement of the size of the tumor with obvious enhancement (long arrow). (c) Preablation PTC revealed stent blockages (arrows). (d) Intraductal RFA was performed with a percutaneous RFA catheter using a 0.035 inch guide wire. The two electrodes (arrows) of the RFA catheter were positioned in the area of the occlusion. (e) A balloon catheter moved back and forth through the stent into the duodenum to remove ablated tissue and debris from the stent. (f) Post-ablation PTC revealed the obstruction has been relieved.
Mentions: All patients underwent PTC and percutaneous transhepatic cholangiography biopsy (PTCB) before stent implantation in the initial procedure. The procedure was performed by transhepatic puncture of a branch of the intrahepatic bile duct with a 21-gauge needle, under digital subtraction angiography (DSA) guidance (Artis Zeego, Siemens, Munich, Germany). PTC was then performed to visualize the location, extent and degree of bile duct obstruction using a percutaneous transhepatic cholangiography puncture set (Cook Inc., Bloomington, IN, USA). A 5 F Cobra catheter (Cook Inc.) was introduced into the bile duct with a 0.035 inch guide wire (Cook Inc.). The catheter and guide wire were passed through the stenosis simultaneously into the duodenum or jejunum. The guide wire was then replaced with a 0.035 inch stiff guide wire (Cook Inc.), and a 9 F catheter sheath was advanced along the stiff guide wire with 8 F biopsy forceps passed through the sheath. The sheath was pushed forward forcefully against the upper segment of the stenosis, while the biopsy forceps were introduced to the lesion through the introducing sheath. The PTCB was performed according to Li et al. [12] (Fig 1a). Following PTCB, an inner non-covered stent (Micro-Tech) was placed. Next, an 8.5 F internal–external biliary drainage tube (Cook Inc.) was implanted though the stent to the duodenum until the maximal decrease in serum bilirubin level was achieved.

Bottom Line: The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.Combination treatment was successful for all patients.Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China.

ABSTRACT

Objectives: To determine the safety and feasibility of intraductal radiofrequency ablation (RFA) followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion.

Methods: Fourteen patients with malignant biliary obstruction and blocked metal stents were studied retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were monitored clinically and radiologically. The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.

Results: Combination treatment was successful for all patients. There were no severe complications during RFA or local treatments. All patients had stent patency restored, with a decline in serum bilirubin. Three patients had recurrent jaundice by 195, 237 and 357 days; two patients underwent repeat intraductal RFA; and one required an internal-external biliary drain. The average stent patency time was 234 days (range 187-544 days). With a median follow-up of 384 days (range 187-544 days), six patients were alive, while eight had died. There was no mortality at 30 days. The 3, 6, 12 and 18 month survival rates were 100%, 100%, 64.3% and 42.9%, respectively.

Conclusion: Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

No MeSH data available.


Related in: MedlinePlus