Endobiliary Radiofrequency Ablation in the Treatment of Benign Biliary Strictures

Objective: This study aimed to evaluate the efficacy of endobiliary radiofrequency ablation (RFA) in the percutaneous treatment of benign bilioenteric anastomotic
strictures that are resistant to percutaneous balloon dilatation and long-term drainage.
Materials and Methods: The clinical data of 22 patients who underwent endobiliary RFA between September 2016 and June 2019 were included in the study.
Indications comprised bilioenteric anastomotic strictures secondary to cholecystectomy (n = 8; 36.36%), the Whipple procedure (n = 6; 27.28%), Klatskin tumor (n =
6; 27.28%), and anastomotic strictures related to transplantation (n = 2; 9.09%). In these patients treated with endobiliary RFA, technical and clinical success rates,
recurrence, and procedure-related morbidity and mortality rates were evaluated.
Results: Endobiliary RFA was performed in 19 patients with bilioenteric anastomotic strictures resistant to standard percutaneous treatment, in one patient with
a bilioenteric anastomotic stricture accompanied by a significant stone burden in the bile ducts, and in two patients with post-transplant anastomotic strictures.
Marked reductions in serum biomarkers were observed after the procedure. The mean duration of drainage catheter use prior to endobiliary RFA was 82 days (standard
deviation: 39 days). During this period, seven patients (31.81%) developed symptoms of cholangitis due to catheter-related complications and were treated with
catheter exchange and appropriate antibiotics. The mean symptom-free period after endobiliary RFA and catheter removal was 587 days. No major complications
related to endobiliary RFA were observed. The technical success rate was 100%, and the primary clinical success rate was 95.4%.
Conclusion: Currently, there is no established standard definitive treatment for benign biliary strictures. Recurrence rates associated with all treatment modalities
remain unacceptably high. In our study, endobiliary RFA yielded effective results in a selected group of patients who had been treated with percutaneous interventions
but, despite the benign etiology, could not be freed from catheterization, which significantly impaired patient comfort.