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Meta-Analysis
. 2023 Dec;51(12):3000605231220825.
doi: 10.1177/03000605231220825.

Is endoscopic radiofrequency ablation plus stent placement superior to stent placement alone for the treatment of malignant biliary obstruction? A systematic review and meta-analysis

Chenming Liu  1   2 , Jiaming Dong  1   3 , Yuxing Liu  4   2 , Siyuan Zhang  5 , Ruanchang Chen  1   3 , Haijun Tang  1
Affiliations
Meta-Analysis

Is endoscopic radiofrequency ablation plus stent placement superior to stent placement alone for the treatment of malignant biliary obstruction? A systematic review and meta-analysis

Chenming Liu et al. J Int Med Res. 2023 Dec.

Abstract

Objective: Malignant biliary obstruction (MBO) is a rare disease with a poor prognosis. Recent studies have shown that endoscopic radiofrequency ablation (ERFA) may improve survival. We conducted a systematic review and meta-analysis of the efficacy of ERFA in combination with biliary stent placement for the treatment of MBO.

Methods: The study was registered in INPLASY (number 202340096). The PubMed, Cochrane Library, Web of Science, and Embase databases were searched from inception to April 2023. We selected studies comparing the efficacy of ERFA plus stent placement with stent placement alone. The primary outcomes were pooled hazard ratios (HRs) for overall survival and stent patency; the secondary outcomes were the odds ratios (ORs) for adverse events.

Results: Eleven studies (four randomized controlled trials and seven observational studies) were included in the meta-analysis. Pooled analysis showed a difference in survival time between the two groups (HR 0.65, 95% confidence interval [CI] 0.58-0.73, I2 = 40%). However, there were no differences in the duration of stent patency or the incidence of adverse events (HR 1.04, 95% CI 0.84-1.29, I2 = 46%; OR 1.41, 95% CI 1.02-1.96, I2 = 29%).

Conclusions: ERFA has a significant survival benefit for MBO, but does not increase the risk of adverse events.

Keywords: Meta-analysis; adverse event; endoscopic radiofrequency ablation; malignant biliary obstruction; stent patency; survival.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flowchart of studies included in the meta-analysis.
Figure 2.
Figure 2.
Forest plot for the comparison of the overall survival of patients who underwent ERFA plus stent placement or stent placement alone. ERFA, endoscopic radiofrequency ablation; SE, standard error; CI, confidence interval; IV, instrumental variable.
Figure 3.
Figure 3.
Results of the subgroup analyses of the comparison between ERFA plus stent placement and stent placement alone with respect to overall survival, according to (a) Type of study, (b) Sample size, and (c) Type of tumor. ERFA, endoscopic radiofrequency ablation; SE, standard error; CI, confidence interval; IV, instrumental variable.
Figure 4.
Figure 4.
Forest plot for the comparison between ERFA plus stent placement versus stent placement alone with respect to the duration of stent patency. ERFA, endoscopic radiofrequency ablation; SE, standard error; CI, confidence interval; IV, instrumental variable.
Figure 5.
Figure 5.
Results of the subgroup analyses of the comparison between ERFA plus stent placement and stent placement alone with respect to the duration of stent patency, according to (a) Type of study and (b) Sample size. ERFA, endoscopic radiofrequency ablation; SE, standard error; CI, confidence interval; IV, instrumental variable.
Figure 6.
Figure 6.
Forest plot for the comparison between ERFA plus stent and stent alone with respect to post-ERCP adverse events. (a) Pancreatitis. (b) Cholangitis. (c) Hemorrhage. (d) Cholecystitis. (e) All adverse events. ERFA, endoscopic radiofrequency ablation. ERCP, endoscopic retrograde cholangiopancreatography; SE, standard error; CI, confidence interval; IV, instrumental variable.
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