SIR 2024
Gastrointestinal Interventions
Ali Husnain, MD (he/him/his)
Research Specialist
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Aziz Aadam, MD
Director of Interventional Endoscopy
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Juan Caicedo-Ramirez, M.D.
Attending Physician
Northwestern Memorial Hospital
Disclosure information not submitted.
Allison Reilland, n/a
Clinical Nurse
Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital
Disclosure information not submitted.
Riad Salem, MD, FSIR, MBA
Professor
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Ahsun Riaz, MD
Associate Professor, Interventional Radiology
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Fifteen patients (M/F = 8/7; median age: 57 [33-84]) who underwent endobiliary RFA for resistant (refractory to conventional balloon dilatation) benign biliary strictures from February 2022 to September 2023 (anastomotic [n = 8], non-anastomotic [n= 7]) were included. Etiology of the strictures included post-liver transplant (n=6), post-cholecystectomy (n=5), post-Whipple procedure (n=1), post-Billroth II surgery (n=1), post-pancreatitis (n=1), and IgG4 cholangiopathy (n=1). Technical success was defined as luminal gain with improved flow. Clinical success was defined as the absence of stricture recurrence following stent/drain removal on post-procedure follow-up.
Results: 16 endobiliary RFA procedures were performed in 15 patients. Technical success was achieved in 16/16 (100%) cases. All patients had at least one session of unsuccessful cholangioplasty of the benign stricture followed by drain placement. All (16/16) cases had upsizing of their percutaneous transhepatic biliary drains present before the procedure. Endoscopy was performed in all cases to visualize the stricture and exclude malignancy. The median fluoroscopy time and dose were 18 minutes (0.5-62.2) and 308.5 mGy (1-2079). There was no procedure-related mortality. Complications included drain leakage (1/16), which was managed with upsizing of the drainage catheter. The median follow-up was 11.5 months (0-16). Of 13 cases having stents/drains removed on follow-up, clinical success was achieved in 11/13 (84.6%) cases. There was a significant decrease in the median number of IR visits (7 [1-51] to 1 [0-9]; p=0.003) and drain insertion/exchange procedures (5 [1-45] to 0 [0-6]; p = 0.002) before and after RFA.
Conclusion: Percutaneous endobiliary RFA is a safe and effective procedure for managing resistant benign biliary strictures. However, prospective studies with larger sample sizes and longer follow-ups are required to get robust data.