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Background <p>Intra-stent radiofrequency ablation (IS-RFA) is an alternative for treating ingrowth occlusions after metal stent (MS) deployment; however, its utility remains uncertain. This study aimed to examine the utility of IS-RFA compared with plastic stent (PS) placement for ingrowth occlusion after bilateral uncovered MS placement in patients with malignant hilar biliary obstruction.</p> Methods <p>In total, 148 patients met the inclusion criteria. The technical and clinical success rates, recurrent biliary obstruction (RBO), and adverse events were compared between the IS-RFA and PS placement groups. Propensity score matching was performed to adjust for between-group differences.</p> Results <p>The technical success rate did not significantly differ between the IS-RFA and PS groups (92.8 versus 85.0%, <i>P</i> = 0.481), whereas the clinical success rate in the IS-RFA group was significantly lower than that in the PS group (70.3 versus 94.1%, <i>P</i> = 0.013). No significant group differences were observed in the rates of early and late adverse events. Among patients who achieved clinical success, the RBO incidence rate did not differ significantly between the groups at 42.3% and 56.3%, respectively (<i>P</i> = 0.429). However, the median time to RBO in the IS-RFA group was significantly longer than that in the PS group (163&#xa0;days versus 89&#xa0;days, <i>P</i> = 0.015). The IS-RFA group had a significantly lower mean total number of reintervention procedures than the PS group (1.4 versus 2.5, <i>P</i> = 0.038).</p> Conclusions <p>IS-RFA may be a useful option for ingrowth occlusion after bilateral MS placement. However, measures are needed to improve the clinical success rate for a standard treatment.</p>

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Intra-stent Radiofrequency Ablation Versus Plastic Stent Placement for Ingrowth Occlusion After Bilateral Metal Stenting in Patients with Malignant Hilar Biliary Obstruction: A Multicenter Propensity Score-Matched Analysis

  • 期刊论文

  • 发表日期：

    2025年7月28日

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  • Tadahisa Inoue,
  • Michihiro Yoshida,
  • Kenta Kachi,
  • Rena Kitano,
  • Mayu Ibusuki,
  • Naoaki Yamada,
  • Fumihiro Okumura,
  • Itaru Naitoh

摘要

Background

Intra-stent radiofrequency ablation (IS-RFA) is an alternative for treating ingrowth occlusions after metal stent (MS) deployment; however, its utility remains uncertain. This study aimed to examine the utility of IS-RFA compared with plastic stent (PS) placement for ingrowth occlusion after bilateral uncovered MS placement in patients with malignant hilar biliary obstruction.

Methods

In total, 148 patients met the inclusion criteria. The technical and clinical success rates, recurrent biliary obstruction (RBO), and adverse events were compared between the IS-RFA and PS placement groups. Propensity score matching was performed to adjust for between-group differences.

Results

The technical success rate did not significantly differ between the IS-RFA and PS groups (92.8 versus 85.0%, P = 0.481), whereas the clinical success rate in the IS-RFA group was significantly lower than that in the PS group (70.3 versus 94.1%, P = 0.013). No significant group differences were observed in the rates of early and late adverse events. Among patients who achieved clinical success, the RBO incidence rate did not differ significantly between the groups at 42.3% and 56.3%, respectively (P = 0.429). However, the median time to RBO in the IS-RFA group was significantly longer than that in the PS group (163 days versus 89 days, P = 0.015). The IS-RFA group had a significantly lower mean total number of reintervention procedures than the PS group (1.4 versus 2.5, P = 0.038).

Conclusions

IS-RFA may be a useful option for ingrowth occlusion after bilateral MS placement. However, measures are needed to improve the clinical success rate for a standard treatment.