Malign Safra Yolu Darlıklarında Perkütan Endobiliyer Radyofrekans Ablasyonun Etkisi

Amaç: Bu çalışmanın amacı, malign biliyer darlıklarda stent açıklığını artırmak için kullanılan perkütan endobiliyer radyofrekans ablasyon (endobiliary radiofrequency ablation, ERFA) yönteminin uygulanabilirliğini ortaya koymaktır. Gereç ve Yöntemler: Çeşitli ilerlemiş tümörlere sekonder malign biliyer stenoz gelişen ve perkütan biliyer drenaj sonrası ERFA ve metalik stent uygulanan 9 (36%) kadın ve 16 (64%) erkek olmak üzere toplam 25 hasta geriye dönük olarak değerlendirildi. Hastaların ortanca sağkalım ve stent açıklığı değerlerinin gösterilmesi için obstruksiyona sebep olan malignitelerin türleri ile işlem sonrası takipleri değerlendirildi. Stent açıklığı ve sağkalım oranları Kaplan-Meier yöntemi kullanılarak hesaplandı. Bulgular: Bu çalışmaya dahil edilen 25 hastadan 17'si (%68) işlem sonrası ilk hafta bilirubin değerlerinde pre-biliyer drenaj değerlerine göre %50'den fazla azalma ile anlamlı bir düşüş gösterdi. Bu tedavi yaklaşımının genel klinik başarı oranı %68 olarak tespit edildi. ERFA ve metalik stent uygulanan 25 hastanın 8'inde (%32) 180 gün içinde stent tıkanıklığı gelişti. Ayrıca 18 (%72) hasta malignite progresyonu sonucu hayatını kaybetti. Tedavi sonrası 30 ve 180 gündeki ölüm oranları sırasıyla %24 ve %72 olarak belirlendi. Ortanca hayatta kalma ve stent açık kalma süreleri sırasıyla 65 ve 70 gündü. Sonuç: Perkütan ERFA ve metalik stentleme, özellikle distal biliyer stenozu olan seçilmiş hasta gruplarında sağkalımı ve stent açıklığını iyileştirme potansiyeline sahiptir. Bu sonuçları doğrulamak için randomize kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Malign Biliyer Darlık, Perkütan endobiliyer radyofrekans ablasyon, biliyer drenaj, biliyer stent

Effect of Percutaneous Endobiliary Radiofrequency Ablation in Malignant Bile Stenosis

Aim: This study aimed to demonstrate the feasibility of the percutaneous endobiliary radiofrequency ablation (ERFA) method, which is used to increase stent patency in malignant biliary strictures. Material and Methods: A total of 25 patients, 9 (36%) female and 16 (64%) male, who developed malignant biliary stenosis secondary to various advanced tumors and underwent ERFA and metallic stenting after percutaneous biliary drainage were retrospectively evaluated. The types of malignancies causing obstruction and the follow-up after the procedure were evaluated to demonstrate the median survival and stent patency values of the patients. Stent patency and survival rates were calculated using the Kaplan-Meier method. Results: The results of the study demonstrated that 17 (68%) out of these 25 patients displayed a significant decrease in their first-week postoperative bilirubin values, with a reduction of greater than 50% compared to the pre-biliary drainage values. The study determined that this treatment approach's overall clinical success rate was 68%. Stent occlusion developed within 180 days in 8 (32%) out of the 25 patients who underwent ERFA and metallic stenting. Additionally, 18 (%72) patients died as a result of malignancy progression. The mortality rates at post-treatment 30 and 180 days were determined to be 24% and 72%, respectively. The median survival and stent patency times were 65 and 70 days, respectively. Conclusion: Percutaneous ERFA and metallic stenting have the potential to improve survival and stent patency, especially in selected patient groups with distal biliary stenosis. Randomized controlled studies are needed to confirm these results.

Keywords:

Malignant biliary obstruction, Percutaneous endobiliary radiofrequency ablation, Biliary drainage, Biliary stenting,

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