Endoscopic radiofrequency ablation may be preferable in the management of malignant biliary obstruction: A systematic review and meta‐analysis

作者：Xiao Zheng, Zhi Yuan Bo, Wei Wan, Ye Wu, Tian Tian Wang, Jun Wu, Dao Jian Gao, Bing Hu · 发表于：Journal of Digestive Diseases · 年份：2016 · DOI：10.1111/1751-2980.12429 · 被引用次数：52 · 研究领域：Gallbladder and Bile Duct Disorders、Cholangiocarcinoma and Gallbladder Cancer Studies、Pediatric Hepatobiliary Diseases and Treatments

OBJECTIVE: Endoscopic biliary radiofrequency ablation (RFA) has been increasingly used to treat unresectable malignant biliary obstruction (MBO). We aimed to perform this systematic review and meta-analysis to evaluate the efficacy and safety for the treatment of malignant biliary obstruction (MBO) and its impact on patient's survival. METHODS: A comprehensive search of the Cochrane Library, PubMed and EMBASE databases was conducted. A meta-analysis was performed by extracting the data from the included studies with regard to technical effectiveness, overall survival, adverse events and mortality of endoscopic RFA. RESULTS: A total of nine studies comprising 263 patients with MBO were included in the analysis. There was a significant increase in the diameter of stricture (3.446 mm, 95% confidence interval [CI] 3.356-3.536 mm) after the endoscopic biliary RFA. The overall survival time was 9.62 months, with pooled 30-day, 90-day and 2-year mortality rates of 2% (95% CI 0.5-5.9%), 21% (95% CI 5-37%), and 48% (95% CI 37-59%), respectively. The pooled rate of adverse events was 17% (95% CI 10-25%), and most complications were mild and managed conservatively. Severe adverse events occurred in three patients (two deaths due to hemobilia and one with partial liver infarction). CONCLUSIONS: Endoscopic biliary RFA is effective and generally safe in the management of unresectable biliary malignancies, and may improve patients' overall survival. Prospective, randomized controlled studie...