Endoscopic intraductal radiofrequency ablation for extrahepatic cholangiocarcinoma: An update (2023)

Table 1 Randomized controlled trials of endoscopic intraductal radiofrequency ablation for malignant biliary obstruction

Ref.	No. of patients		Etiology	Location	ID-RFA catheter	ID-RFA setting	Stent type	No. of ID-RFA applications	Stent patency period (median/mean)			Survival period (median/mean)			Adverse event rate
	RFA + stent	Stent							ID-RFA + stent	Stent	P value	ID-RFA + stent	Stent	P value	ID-RFA + stent	Stent	P value
Yang et al[9], 2018	32	33	Cholangiocarcinoma	Distal, hilar	Habib	7-10W; 90s	PS	Every 3 ma	6.8 mb	3.4 mb	0.02	13.2 m	8.3 m	< 0.001	6.3%	9.1%	0.67
Kang et al[10], 2021c	24	24	Cholangiocarcinoma, pancreatic cancer, other	Distal, Hilar	ELRA	7W/10W; 120s; 80℃	UMS	1	132 d	116 d	0.440	244 m	180 m	0.281	4.2%	12.5%	0.609
Gao et al[11], 2021	87	87	Cholangiocarcinome	Distal, hilar	Habib	7-10W; 90s	PS	2	3.7 m	4.1 m	0.674	14.3 m	9.2 m	< 0.001	27.6% (early event)	19.5% (early event)	0.211
Kang et al[12], 2022	15	15	Cholangiocarcinoma, gallbladder cancer	Hilar	ELRA	7W; 60-120s; 80℃	UMS	1-2	178 d	122 d	0.154	230 d	144 d	0.643	NA	NA	NS
Albers et al[13], 2022	42	44	Cholangiocarcinoma, pancreatic cancer, other	Distal, Hilar	Habib	10W; 90s	UMS	1	NAd	NAd	NAd	NAd	NAd	NAd	10.5%	2.3%	P = 0.18

^aID-RFA was repeated if the bile duct wall thickness was > 6 mm by intraductal ultrasonography every 3 mo.

^bStent replacement was performed every 3 mo even if it was not occluded.

^cCases of percutaneous approaches were also included.

^dCases of ampullary cancer were also included.

^eStent patency and overall survival rates after 3 and 6 mo did not differ significantly between groups.

ID-RFA: Intraductal radiofrequency ablation; PS: Plastic stent; UMS: Uncovered metal stent; NA: Not applicable; NS: Not significant.

Table 2 Comparative studies of endoscopic intraductal radiofrequency ablation with chemotherapy for extrahepatic cholangiocarcinoma

Ref.	Treatment	No. of patients	Location	Metastatic, %	ID-RFA catheter	Stent type	No. of ID-RFA applications	Stent patency period (median)		Progression free survival (median)		Overall survival (median)
Yang et al[16], 2020	S-1 chemotherapy + ID-RFA	37	Distal, Hilar	0	Habib	PS	3.3 (mean)	6.6 m	P = 0.014	12 m	P < 0.001	16.0 m	P < 0.001
	ID-RFA	38	Distal, Hilar	0	Habib	PS	2.4 (mean)	5.6 m		7 m		11.0 m
Gonzalez-Carmona et al[17], 2022	GEM-based chemotherapy + ID-RFA	40	Distal, Hilar	37.5	Habib	PS	1-21	NA	NA	12.9 m	P = 0.045	17.3 m	P = 0.004
	GEM-based chemotherapy	26	Distal, Hilar	50.0	Habib	PS	-	NA		5.7 m		8.6 m
Inoue et al[18], 2022	GEM with cisplatin + ID-RFA	25	Distal, Hilar	48	Habib	UMS	1.84 (mean)	10.7 m	P = 0.048	8.6 m	P = 0.014	17.1 m	P = 0.017
	GEM with cisplatin	25	Distal, Hilar	60	Habib	UMS	-	5.2 m		5.8 m		11.3 m

ID-RFA: Intraductal radiofrequency ablation; PS: Plastic stent; GEM: Gemcitabine; NA: Not applicable; UMS: Uncovered metal stent.