Radiofrequency ablation for ampullary neoplasia with intraductal extension after endoscopic papillectomy: Systematic review and meta-analysis.

Autor:	Landim DL; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil., de Moura DTH; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil., Hirsch BS; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil., de Oliveira GHP; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil., Veras MO; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil., Nunes FG; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil., Cavassola PRP; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil., Bernardo WM; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil., Mahmood S; Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States., de Moura EGH; Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Endoscopy international open [Endosc Int Open] 2024 Mar 28; Vol. 12 (3), pp. E440-E447. Date of Electronic Publication: 2024 Mar 28 (Print Publication: 2024).
DOI:	10.1055/a-2226-0928
Abstrakt:	Background and study aims Noninvasive ampullary neoplasms may be removed by surgery or endoscopy. However, given the morbidity and mortality associated with surgery, endoscopic papillectomy (EP) is the preferred approach. Radiofrequency ablation (RFA) after EP has emerged as a promising alternative therapy to avoid surgery after incomplete EP. Our goal was to evaluate the efficacy and safety of RFA for residual or recurrent lesions with intraductal extension after endoscopic papillectomy. Patients and methods The inclusion criteria include clinical trials, cohort studies, and case series evaluating patients with residual or recurrent lesions with intraductal extension after EP treated with RFA. Case reports, duplicated data, and studies with follow-up periods < 10 months were excluded. The metanalysis evaluated adverse events, surgical conversion rate, clinical success and recurrence. Results Seven studies were selected, totaling 124 patients. RFA was associated with a clinical success rate of 75.7% (95% confidence interval [CI] 65.0-88.0%; I 2 = 23.484) in a mean follow-up period < 10 months. However, the biliary stricture rate was 22.2% (95% CI 12.1-28.4%; I 2 = 61.030), 14.3% of pancreatitis (95% CI 8.8-22.3%; I 2 < 0.001), 7.0% of cholangitis (95% CI 3.3-14.5%; I 2 < 0.001), 4.0% of bleeding (95% CI 1.7-9.3%; I 2 < 0.001), and recurrence of 24.3% (95% CI 16.0-35.0%; I 2 = 23.484). Conclusions RFA is feasible and appears to be effective for managing residual or recurrent lesions with intraductal extension after EP. However, long-term follow-up and high-quality studies are required to confirm our findings. 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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