PURPOSE: To prove feasibility and safety of percutaneous endoluminal radiofrequency ablation (eRFA) using a monopolar approach in treatment of occluded biliary stent in malignancy. MATERIALS AND METHODS: The study included 11 patients with occluded biliary metal stent that had been implanted due to malignant biliary obstruction. All underwent metal stent recanalization by percutaneous eRFA in monopolar setting. Sixteen eRFA procedures were performed under fluoroscopic guidance with an EndoHPB 8F radiofrequency ablation catheter. The effect of stent recanalization was assessed based upon change from pre- to post-procedural diameter of the patent lumen of the metal stent (Wilcoxon test), primary and secondary stent patency (compared by log-rank test), catheter-free period, and overall survival. Adverse events were evaluated according to Common Terminology Criteria for Adverse Events (CTCEA) 4.0. RESULTS: Recanalization of the metal stent by monopolar radiofrequency ablation was successful in all 11 patients. Diameter of the patent lumen of the stent significantly widened after the eRFA inside the stent (median 2 vs. 7 mm, p = 0.003). Grade 1 complications were observed in one-third of procedures. Median stent patency after recanalization by eRFA was non-inferior to primary metal stent patency (154 vs. 161 days, p = 0.27). Median catheter-free survival and overall survival after stent recanalization were 149 and 210 days, respectively. CONCLUSION: Endoluminal radiofrequency ablation in monopolar setting was shown to be a feasible and safe method for recanalization of occluded biliary metal stents. LEVEL OF EVIDENCE: Level 4, Case Series.

Department of Biophysics Faculty of Medicine Masaryk University Brno 625 00 Czech Republic

Department of Radiology and Nuclear Medicine Faculty of Medicine University Hospital Brno Masaryk University Brno 625 00 Czech Republic

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Pai M, Valek V, Tomas A, Doros A, Quaretti P, Golfieri R, et al. Percutaneous intraductal radiofrequency ablation for clearance of occluded metal stent in malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol. 2014;37:235–40. DOI

Lossef SV, Druy E, Jelinger E, Fleischer D, Barth KH. Use of hot-tip laser probes to recanalize occluded expandable metallic biliary endoprostheses. Am J Roentgenol. 1992;158:199–201. DOI

Steel AW, Postgate AJ, Khorsandi S, Nicholls J, Jiao L, Vlavianos P, et al. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc. 2011;73:149–53. DOI

Mizandari M, Kumar J, Pai M, Chikovani T, Azrumelashvili T, Reccia I, et al. Interventional radiofrequency ablation: a promising therapeutic modality in the management of malignant biliary and pancreatic duct obstruction. J Cancer. 2018;9:629–37. DOI

Bernard V, Andrašína T, Mornstein V, Válek V. Radiofrequency tissue ablation inside of metal stent—a thermographic study. IRBM. 2014;35:164–9. DOI

Wu T-T, Li H-C, Li W-M, Ao G-K, Lin H, Zheng F, et al. Percutaneous intraluminal radiofrequency ablation for malignant extrahepatic biliary obstruction: a safe and feasible method. Dig Dis Sci. 2015;60:2158–63. DOI

Lee JM, Han JK, Kim SH, Sohn KL, Lee KH, Ah SK, et al. A comparative experimental study of the in-vitro efficiency of hypertonic saline-enhanced hepatic bipolar and monopolar radiofrequency ablation. Korean J Radiol. 2003;4:163. DOI

Goldberg SN, Ryan TP, Hahn PF, Schima W, Dawson SL, Lawes KR, et al. Transluminal radiofrequency tissue ablation with use of metallic stents. J Vasc Interv Radiol. 1997;8:835–43. DOI

Mizandari M, Pai M, Xi F, Valek V, Tomas A, Quaretti P, et al. Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol. 2013;36:814–9. DOI

Xia N, Gong J, Lu J, Chen Z-J, Zhang L-Y, Wang Z-M. Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: a preliminary result. World J Gastroenterol. 2017;23:1851–6. DOI

Inoue T, Ito K, Yoneda M. Novel balloon catheter-based endobiliary radiofrequency ablation system: ex-vivo experimental study. Dig Endosc. 2020;32:974–8. DOI

Rohan T, Andrasina T, Juza T, Matkulcik P, Červinka D, Svobodova I, et al. Experimental model of occluded biliary metal stent recanalization using irreversible electroporation via a tubular catheter. Int J Hyperthermia. Taylor & Francis; 2021;38:393–401.