Percutaneous Endoluminal Radiofrequency Ablation Combined with Biliary Stenting for Malignant Biliary Obstruction: A Retrospective Single-center Study

Percutaneous Endoluminal Radiofrequency Ablation and Biliary Stenting

Abstract

Objective: To assess the safety and clinical outcomes of combining percutaneous endoluminal radiofrequency ablation (RFA) with biliary stenting for malignant biliary obstruction.
Methods: We retrospectively evaluated 37 consecutive patients treated at a single center between 2013 and 2025 with percutaneous endoluminal RFA followed by metal stent placement for malignant biliary obstruction. Technical success, biochemical response, procedure-related complications, primary stent patency, recurrent biliary obstruction (RBO), and overall survival were evaluated. The 30-day biochemical analysis was restricted to patients who were alive at day 30 and had paired bilirubin measurements available. Kaplan-Meier analysis was used to estimate death-censored primary stent patency and overall survival, and an additional competing-risk analysis was performed for RBO with death without prior RBO treated as a competing event.
Results: Technical success was achieved in all patients (100%). Among the 24 patients who were alive at day 30 and had paired bilirubin measurements available, mean total bilirubin decreased from 7.41 ± 5.84 to 2.04 ± 1.46 mg/dL and mean direct bilirubin from 5.69 ± 4.46 to 1.57 ± 1.15 mg/dL (both p < 0.001). Modified CIRSE Grade 3a procedure-related complications occurred in three patients (8.1%), whereas no Grade 4-5 procedure-related complications occurred and there was no procedure-related mortality (Grade 6). RBO developed in three of the 35 patients included in the time-to-event analyses (8.6%). The competing-risk cumulative incidence of RBO was 3.5% at 90 and 180 days and 8.9% at 365 days. Median death-censored primary stent patency was 367 days [95% confidence interval (CI), 181 days to not estimable], and median overall survival was 95 days (95% CI, 77-112 days).
Conclusion: Percutaneous biliary drainage followed by endoluminal RFA and SEMS placement was technically feasible and had an acceptable safety profile, with biliary decompression observed among patients evaluable at day 30. The low cumulative incidence of RBO was encouraging, but the small number of events, substantial competing mortality, and lack of a control group limit interpretation and prevent assessment of the independent contribution of RFA.