Clinical Study Of ERCP Combined With Endobiliary Radiofrequency Ablation In The Treatment Of Advanced Malignant Biliary Obstruction

BackgroundThe tumors bringing about biliary obstruction are generally with earlier metastasis,low surgical radical cure rate,and poor prognosis.In addition to the general characteristics of tumors,a series of specific pathophysiological changes,such as obstructive jaundice,biliary tract infections,pruritus,serious interference with the daily lives of patients,are deriving from biliary obstruction.Since these kinds of tumors are fail to operate,we hope to ease the suffering of patients and prolong their lives through simpler methods,such as biliary-intestinal anastomosis and stent implantion.Our department began the Endoscopic retrograde cholangiopancreatography(ERCP)20 years ago.It has developed from simple biliary drainage and stone removal to the acquisition pathology of hepatobiliary and duodenal tumors,and the treatment of advanced malignant biliary tract obstruction what will be discussed in this article.ObjectiveThe research investigated retrospectively the curative effects and complications of patients with advanced malignant biliary tract obstruction treated by the placement of self-expanding metal stents(SEMS)combined with endobiliary radiofrequency ablation(ERFA),or SEMS only,or plastic stents(PS)only.Methods57 cases of clinical data diagnosed with advanced malignant biliary tractobstruction in our department collected from March 2014 to December 2017,were detected.The patients were divided into three groups: 23 patents underwent ERFA with SEMS(ERFA group),16 patents underwent SEMS only(SEMS group),18 patents underwent PS only(PS group).ResultsSerious surgery-related complications such as massive hemorrhage,gastrointestinal perforation,or bile leakage were not observed.It has been shown that 4 cases of postoperative pancreatitis(PEP)occurred in ERFA group,1 case occurred in SEMS group,and 2 cases occurred in PS group.And when it comes to the cases of surgery-related abdominal pain,the figure observed were 2,0 and 1.Only1 case of infection of biliary tract were observed in the ERFA group.After the surgery,patients,serum bilirubin were shown an apparent decline(P <0.05)and pruritus symptoms improved(P <0.05),both have significant statistical differences.Moreover,a better performance were saw in ERFA group(P <0.05)comparing with the other two.Here is the data of median patency time of the stent :9.2 months(95%CI:8.2-10.2 months)in the ERFA group,7.3 months(95%CI:5.7-8.9 months)in the SEMS group,and 4.3 months(95%CI:3.1-5.5 months)in the PS group.The median survival time:10.1months(95%CI:7.5-12.7 months)in the ERFA group,7.8 months 95%CI : 6.2-9.4 months)in the SEMS group,and4.9months(95%CI:3.2-6.6 month)in the PS group.ConclusionsERFA combining SEMS can prolong the patency time and the overall survival time meanwhile ease bilirubinemia and pruritus with fewer complications.