PMID- 38188927 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240320 IS - 2364-3722 (Print) IS - 2196-9736 (Electronic) IS - 2196-9736 (Linking) VI - 12 IP - 1 DP - 2024 Jan TI - Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis. PG - E23-E33 LID - 10.1055/a-2204-8316 [doi] AB - Background and study aims Recurrent biliary stent occlusion and tumor ingrowth remain a major concern among patients with malignant biliary obstruction (MBO) with significant impact on patient morbidity and survival. Intraductal radiofrequency ablation (RFA) has emerged as a promising treatment that seeks to extend stent patency. This study aimed to evaluate the impact of RFA on overall survival (OS) and stent patency among patients with unresectable MBO. Methods A comprehensive search of electronic databases was performed for randomized controlled trials (RCTs) comparing RFA plus biliary stent (RFA+S) versus biliary stent alone (S-alone). Outcomes assessed included overall survival, stent patency, and adverse events (AEs) with mean difference (MD) calculated from pooled proportions. Subgroup analyses were performed for hilar strictures and cholangiocarcinoma (CCA). Results Six RCTs (n=439 patients) were included and demonstrated improved survival among patients who received RFA+S (MD 85.80 days; 95% confidence interval [CI] 35.02-136.58; I (2) =97%; P <0.0009). The pooled MD for total stent patency was 22.25 days (95% CI 17.38-61.87; I (2) =97%; P =0.27). There was no difference in AEs between RFA+S vs S-alone ( P >0.05). On subgroup analyses, RFA+S was associated with improved stent patency (MD 76.73 days; 95% CI 50.11-103.34; I (2) =67%; P <0.01) and OS (MD 83.14 (95% CI 29.52-136.77; I (2) =97%; P <0.01] for CCA. For hilar strictures, stent patency was improved among patients with RFA+S [MD 83.71 days (95% CI 24.85-142.56; I (2) =84%; P <0.01]. Conclusions RFA+S improved OS in the treatment of MBO when compared with S-alone. Moreover, the RFA therapy prolonged stent patency in hilar strictures and CCA, with similar rates of AEs. CI - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). FAU - de Oliveira Veras, Matheus AU - de Oliveira Veras M AUID- ORCID: 0000-0001-9881-9855 AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - de Moura, Diogo Turiani Hourneaux AU - de Moura DTH AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - McCarty, Thomas R AU - McCarty TR AUID- ORCID: 0000-0003-4517-5261 AD - Internal Medicine, Yale University School of Medicine, New Haven, United States. RINGGOLD: 12228 FAU - de Oliveira, Guilherme Henrique Peixoto AU - de Oliveira GHP AUID- ORCID: 0000-0002-1057-2390 AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - Gomes, Romulo Sergio Araujo AU - Gomes RSA AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - Landim, Davi Lucena AU - Landim DL AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - Nunes, Felipe Giacobo AU - Nunes FG AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - Franzini, Tomazo Antonio Prince AU - Franzini TAP AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - Lera Dos Santos, Marcos Eduardo AU - Lera Dos Santos ME AUID- ORCID: 0000-0001-9759-3807 AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - Bernardo, Wanderley Marques AU - Bernardo WM AD - Gastroenterology, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 FAU - de Moura, Eduardo Guimaraes Hourneaux AU - de Moura EGH AD - Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil. RINGGOLD: 117265 LA - eng PT - Journal Article PT - Review DEP - 20240105 PL - Germany TA - Endosc Int Open JT - Endoscopy international open JID - 101639919 EIN - Endosc Int Open. 2024 Mar 18;12(3):4. PMID: 38504748 PMC - PMC10769587 OTO - NOTNLM OT - PTCD/PTCS OT - Strictures COIS- Conflict of Interest Dr. Diogo Turiani Hourneaux De Moura: BariaTek Medical - Advisory Board Member (Consulting fees). This was not relevant to this study. Dr. Eduardo Guimaraes Hourneaux De Moura: Olympus - Consultant (Consulting fees) and Boston Scientific - Consultant (Consulting fees). These were not relevant to this study. The other authors declare no potential conflict of interest. EDAT- 2024/01/08 06:42 MHDA- 2024/01/08 06:43 PMCR- 2024/01/01 CRDT- 2024/01/08 05:26 PHST- 2023/07/30 00:00 [received] PHST- 2023/10/24 00:00 [accepted] PHST- 2024/01/08 06:43 [medline] PHST- 2024/01/08 06:42 [pubmed] PHST- 2024/01/08 05:26 [entrez] PHST- 2024/01/01 00:00 [pmc-release] AID - EIO-2023-07-3083-REV [pii] AID - 10.1055/a-2204-8316 [doi] PST - epublish SO - Endosc Int Open. 2024 Jan 5;12(1):E23-E33. doi: 10.1055/a-2204-8316. eCollection 2024 Jan.