Percutaneous Endobiliary Radiofrequency Ablation Using Habib Probe for Unresectable Cholangiocarcinoma: Safety, Technical Feasibility, and Clinical Outcomes

Purpose: Cholangiocarcinoma (CCA) frequently presents at an advanced stage where curative resection is not feasible, necessitating palliative interventions to relieve biliary obstruction. Endobiliary radiofrequency ablation (RFA) has been explored as an adjunct to biliary stent placement to improve biliary patency, yet data on its percutaneous application remain limited {1-4}. This study evaluates the safety, technical success, and clinical outcomes of percutaneous RFA with the Habib™ EndoHPB probe in unresectable CCA.

Materials and Methods: We retrospectively reviewed 8 patients (mean age 59.9 ± 6.2 years; 4 males, 4 females) with unresectable intrahepatic CCA who underwent percutaneous endobiliary RFA between January 2022 and June 2025. RFA was performed with an electrocautery system (Erbe VIO 300 D ) at 10 W for 90 sec. The entire RFA procedure, including catheter placement, was performed within 5-10 minutes, depending on the number of treatments. Procedural details, liver function tests, technical success, clinical success (≥50% bilirubin reduction or symptom resolution within 14 days), and adverse events were analyzed.

Results: Technical success was achieved in all patients (100%). Clinical success was observed in 7 of 8 patients (87.5%). No major adverse events occurred; all patients experienced only transient, mild post-ablation pain. Targeted ablation sites included the right hepatic duct (n=6), left hepatic duct (n=6), common bile duct (n=3), common hepatic duct (n=1), and porta hepatis (n=1), with several patients having multilevel involvement.

Balloon dilatation was performed in all patients (sizes 6-12 mm), optimizing luminal patency. Drain exchange intervals improved substantially: pre-RFA exchanges occurred every 1-3 weeks, while post-RFA intervals extended to 4-8 weeks. Mean IR visits for tube exchanges decreased from 4.0 ± 1.6 to 2.3 ± 0.6 (p=0.133). Laboratory outcomes demonstrated improvements: total bilirubin declined from 5.5 ± 7.6 mg/dL to 2.7 ± 2.7 mg/dL at 1 month (p=0.187); AST decreased from 85.9 ± 48.1 U/L to 59.7 ± 39.5 U/L (p=0.005); ALT decreased from 104.7 ± 76.2 U/L to 56.1 ± 50.8 U/L (p=0.054). Over a mean follow-up of 398.6 ± 562.3 days, 3 patients (37.5%) achieved drain internalization, while 2 patients died from disease progression unrelated to the RFA procedure.

Conclusion: Percutaneous endobiliary RFA with the Habib probe is a safe and technically feasible intervention for unresectable CCA, yielding high procedural success, favorable laboratory and clinical outcomes, reduced IR utilization, and potential drain internalization.