Percutaneous Intraductal Microwave Ablation and Self-expandable Metallic Stenting: A New Treatment Method for Malignant
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CLINICAL INVESTIGATION
BILIARY
Percutaneous Intraductal Microwave Ablation and Selfexpandable Metallic Stenting: A New Treatment Method for Malignant Extrahepatic Biliary Obstruction Rıdvan Pekc¸evik1
•
¨ mu¨r Ballı1 O
Received: 16 May 2020 / Accepted: 7 October 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To evaluate the patency and clinical efficacy of percutaneous intraductal microwave ablation (PIMWA) and uncovered self-expandable metallic stents (USEMs) in inoperable malignant extrahepatic biliary obstruction. Materials and methods The procedures to be performed on patients with malignant inoperable extrahepatic biliary obstruction were decided by a multidisciplinary team including an interventional radiologist. In our study, 141 patients were evaluated retrospectively. Twenty-one patients who underwent PIMWA ? USEMs with the MedWaves AveCure microwave system (AveCure Intelligent Controller and Super-Flex Smart Catheter) and met the inclusion criteria were included in the study. Complications related to the intervention, stent patency, survival time, serum bilirubin levels, and the general condition of the patients were noted. Results The median stent patency and the median survival time were 108 and 143 days, respectively. The rates of 30-day, 2-month, 6-month and 8-month survival were 95.2%, 85.7%, 38.1%, and 14.3%, respectively. Conclusion The PIMWA ? USEMs procedure is a safe, effective, and minimally invasive alternative palliative treatment method in patients with malignant inoperable extrahepatic biliary obstruction.
& Rıdvan Pekc¸evik [email protected] ¨ mu¨r Ballı O [email protected] 1
Department of Interventional Radiology, ˙Izmir Katip C¸elebi University Atatu¨rk Training and Research Hospital, 35360 I˙zmir, Turkey
Keywords Percutaneous intraductal microwave ablation (PIMWA) Uncovered self-expandable metallic stents (USEMs) Malignant extrahepatic biliary obstruction In-stent restenosis
Introduction Since malignancies leading to biliary obstruction are often diagnosed at advanced stages, surgical treatment is generally not indicated [1, 2]. In such cases, palliative treatment options come into prominence. The main purpose of palliative treatment is to provide biliary drainage [1–3]. This can be performed by percutaneous transhepatic biliary drainage or endoscopic retrograde cholangiopancreatography. It may be necessary to add plastic or metallic stenting to these procedures. Generally, plastic stents are preferred if the life expectancy of the patients is below 3 months, and metallic stents if longer than 3 months. Metallic stents are superior to plastic stents for various reasons, such as their longer patency time and lower cholangitis and migration rates [2, 4, 5]. In daily practice, metallic stents used in biliary stenting are covered or non-covered. Whether covered or noncovered, metallic stents may obstructed due to tumor ingrowth or overgrowth,
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