Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis.

Autor: de Oliveira Veras M; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., de Moura DTH; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., McCarty TR; Internal Medicine, Yale University School of Medicine, New Haven, United States., de Oliveira GHP; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., Gomes RSA; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., Landim DL; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., Nunes FG; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., Franzini TAP; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., Lera Dos Santos ME; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., Bernardo WM; Gastroenterology, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil., de Moura EGH; Gastrointestinal Endoscopy Unit, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil.
Jazyk: angličtina
Zdroj: Endoscopy international open [Endosc Int Open] 2024 Jan 05; Vol. 12 (1), pp. E23-E33. Date of Electronic Publication: 2024 Jan 05 (Print Publication: 2024).
DOI: 10.1055/a-2204-8316
Abstrakt: 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.
Competing Interests: 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.
(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/).)
Databáze: MEDLINE
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