Review of endoscopic radiofrequency in biliopancreatic tumours with emphasis on clinical benefits, controversies and safety

Table 1 Endoscopic ultrasonography-guided radiofrequency ablation on pancreatic tumours

Ref.	n	Indication	Mean size mm (range)	RF device	Thermokinetics	RF sessions	Outcome	Survival (range)	Complications
Armellini et al[31], 2005	1	PNET	20	18 G Needle electrode	NA	NA	Complete ablation	-	No complication
				(STARmed)
Arcidiacono et al[32], 2012	22	Locally advanced PC	36	CTP	18 W (heating)	NA	Significant volume reduction in 16 patients	6 mo1	Early:
			(23-54)		650 psi (cooling)		(P = 0.07)	(1-12)	3 transient abdominal pain
					107 (10-360) s		Technical failure in 6 patients		1 minor duodenal bleeding
									Late:
									2 jaundice
									1 duodenal stricture
									1 cystic fluid collection
Rossi et al[33], 2014	1	PNET	9	Habib EUS RFA	10-15 W	1	Complete thermal ablation	-	No complication
					360 s		No recurrence
							(34 mo follow-up)
Weigt et al[34], 2014	1	IPMN	10	Habib EndoHBP	8 W	NA	2 cm ablation	-	Mild acute pancreatitis
		(recurrent bleeding)			90 s		No rebleeding
							(10 wk follow-up)
Pai et al[27], 2015	8	Mucinous cyst (4)	41 (24-70)	Habib EUS RFA	5-25 W	4.5		-	2 mild abdominal pain
		IPMN (1)	35		90-120 s	(2-7)	2 cyst resolution
		Microcystic adenoma (1)	20				4 cyst reduction
		PNET (2)	27 (15-40)				(48 % reduction)
							2 PNET with vascularity change
Lakhtakia et al[25], 2015	3	Insulinoma	18	18 G Needle electrode	50 W	NA	No recurrent hypoglycemia	-	No complication
		(Hypoglycemia)	(14-22)	(STARmed)	10-15 s		(12 mo follow-up)
Song et al[28], 2016	6	Locally advanced PC (4)	38	18 G	20-50 W	1.3	Necrosis at the ablation site	NA	2 mild abdominal pain
		Metastatic PC (2)	(30-90)	Needle electrode	10 s	(1-2)
				(STARmed)

¹Among 13 patients; 2 patients were lost to follow-up and other patient died during hospitalization. PNET: Pancreatic neuroendocrine tumour; NA: Not available; PC: Pancreatic cancer; IPMN: Intraductal pancreatic mucinous neoplasm.

Table 2 Endoscopic radiofrequency ablation for biliary strictures

Ref.	n	Indication	Stricture length (mm)	Thermokinetics power - time	RF sessions	Technical success	Stricture diameter before RF (mm)	Stricture diameter after RF (mm)	Stent patency (d)	Median survival (mo)	Complications
Pozsár et al[39], 2011	5	Occluded SEMS	15	10 W - 120 s	2 (1-3)	100%	2	4.7	62	-	No complication
		(malignant strictures)							(9-236)
Monga et al[40], 2011	1	CC	15	5 W - 120 s	1	100%	-	-	-	-	No complication
Steel et al[41], 2011	21	16 PC	-	7-10 W	2 (1- 4)	100%	0 (0-1)	4 (3-6)	76%	-	1 hyperamylasemia
		6 Klatskin/intrahepatic CC		120 s					at 90-d FU		2 cholecystitis
											1 rigors
Yoon et al[42], 2012	1	CHD CC	-	7 W - 90 s	2	100%	-	-	-	-	No complication
Mavrogenis et al[43], 2012	1	Intrahepatic adenoma	-	-	-	100%	-	-	-	-	-
Dzeletovic et al[44], 2012	1	Ampullary adenoma	10	1	-	100%	-	-	-	-	CBD stenosis
		with CBD invasion				(Complete ablation)
Sonpal et al[45], 2012	1	Occluded SEMS (Klatskin CC)	-	8 - 10 W	2	100%	-	-	90	-	-
				90 s
Lewis et al[46], 2012	5	4 CC	-	7-10 W	1 (1-2)	100%	-	-	-	-	No complication
		1 colon met.		90 s
Watson et al[47], 2012	3	3 Klatskin CC	2	7-10 W			3	6			No complication
				90 s
Kallis et al[48], 2015	11	Occluded SEMS:	-	-	1	100%	-	-	146	-	No complication
		6 PC/3 CC			(1-2)
		2 liver met
Topazian et al[49], 2013	1	Intrahepatic adenoma		10 W - 90 s	1	100%	-	-	-	-	Hepatic artery pseudoaneurysm
						(Complete ablation)
Figueroa-Barojas et al[50], 2013	20	11 CC/7 PC	15.2	7-10 W	-	100%	1.7	5.2	100%		5 pain
		1 IPMN/1 Met.	(3.5-33)	120 s			(0.5-3.4)	(2.6-9)	at 30-d FU		1 mild pancreatitis and cholecystitis
Alis et al[51], 2013	10	CC	20	10 W - 120 s	3 (3-4)	100%	1.5	5	270	-	2 mild pancreatitis
			(20-35)				(1.5-2)	(4-7)	(180-450)
Lui et al[52], 2013	1	Occluded SEMS		10 W - 150 s	1	100%	-	-	60	-	No complication
		(Klatskin CC)
Law et al[53], 2013	2	PC	-	10 W - 120 s	1	100%	-	-	-	-	-
Tal et al[54], 2014	12	2 intrahepatic CC	-	8-10 W	1	100%	-	-	-	8.5	3 hemobilia (2 deaths)
		8 Klatskin IV CC		60-90 s	(1-5)						3 cholangitis
		2 GB can.
		1 gastric Met

CHD: Common hepatic duct; CBD: Common bile duct; CC: Cholangiocarcinoma; PC: Pancreatic cancer; GB: Gallbladder; SEMS: Self-expanding metal stent; Met: Metastasis; FU: Follow-up.

Table 3 Endoscopic radiofrequency ablation for biliary strictures (continuation)

Ref.	n	Indication	Stricture length (mm)	Thermokinetics power - time	RF sessions	Technical success	Stricture diameter before RF (mm)	Stricture diameter after RF (mm)	Stent patency (d)	Survival (mo)	Complications
Hu et al[55], 2014	9	4 postsurgical	-	10 W - 90 s	1	100%	-	-	-	-	2 abdominal pain
		3 liver transplant				(5 complete resolution					2 transient leucocytosis
		2 chronic inflam				4 improvement)					1 mild pancreatitis
Uppal et al[56], 2014	2	Prehepatic transplant	-	-	-	100%	-	-	-	19-35 mo FU	1 hemobilia
		1 LHD-CHD CC				(No malignancy in explant)
		1 RHD-CHD CC
Strand et al[57], 2014	16	13 Klatskin CC	-	7 W - 90 s	-	100%	-	-	-	9.6	Occurrence/month:
		1 intrahepatic CC									Stent occlusion 0.06
		2 extrahepatic CC									Stent migration 0.02
											Cholangitis 013
											Hepatic abscess 0.02
Dolak et al[58], 2014	58	50 Klatskin CC	-	10 W - 180 s	1	100%	-	-	170	10.6	1 partial liver infarction
		4 PC			(1-5)						5 cholangitis
		1GB can									2 cholangiosepsis
		1 met									3 hemobilia
		1 HCC									1 GB empyema
		1 HCC and CC									1 hepatic coma (1 death)
											1 left bundle branch block
Mukund et al[59], 2014	8	Occluded SEMS:	-	-	1	100%	-	-	114		No complication
		4 GB cancer			(1-2)
		2 CC/2 PC
Mehendiratta et al[60], 2015	1	Ampullary adenoma	-	7 W - 90 s	-	100%	-	-	-	-	No complication
		with CBD invasion				(Complete ablation)
Musquer et al[61], 2015	1	Occluded SEMS	-	10 W - 90 s	-	100%	-	-	180	-	-
		(CC)
Sharaiha et al[62], 2015	69	45 CC	14.5	8 W - 90 s	1	100%	2	4.9	96%	15 for PC	1 pancreatitis
		19 PC	(3.5-60)		(1-4)				at 30-d FU	18 for CC	2 cholecystitis
		1 GB cancer									1 hemobilia
		1 gastric cancer									3 abdominal pain
		3 liver met
Laquière et al[63], 2015	12	CC	19.5	10 W - 90 s	1	100%	-	-	-	12	1 sepsis
		4 Bismuth I	(10-35)		(1-3)						1 cholangitis
		3 Bismuth II
		2 Bismuth III
		3 Bismuth IV
Atar et al[64], 2015	21	Occluded SEMS:	-	10 W - 90 s	1	100%	-	-	62%	-	-
		11 PC/7 CC			(1-5)				at 90-d FU
		1 GB can/2 liver met

LHD: Left hepatic duct; RHD: Right hepatic duct; CHD: Common hepatic duct; CBD: Common bile duct; CC: Cholangiocarcinoma; PC: Pancreatic cancer; HCC: Hepatocellular carcinoma; GB: Gallbladder; SEMS: Self-expanding metal stent; Met: Metastasis; FU: Follow-up.