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Journal of Digestive Diseases 2016; 17; 716–724
Meta analysis
Endoscopic radiofrequency ablation may be preferable in the
management of malignant biliary obstruction: A systematic
review and meta-analysis
Xiao ZHENG, Zhi Yuan BO, Wei WAN, Ye Chen WU, Tian Tian WANG, Jun WU, Dao Jian GAO & Bing HU
Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
OBJECTIVE: Endoscopic biliary radiofrequency
ablation (RFA) has been increasingly used to treat
unresectable malignant biliary obstruction (MBO).
We aimed to perform this systematic review and
meta-analysis to evaluate the efficacy and safety for
the treatment of malignant biliary obstruction
(MBO) and its impact on patient’s survival.
METHODS: A comprehensive search of the
Cochrane Library, PubMed and EMBASE databases
was conducted. A meta-analysis was performed by
extracting the data from the included studies with re-
gard to technical effectiveness, overall survival, adverse
events and mortality of endoscopic RFA.
RESULTS: A total of nine studies comprising 263
patients with MBO were included in the analysis.
There was a significant increase in the diameter of
KEY WORDS: efficacy, malignant biliary obsturction, meta-analysis, radiofrequency albation, safety.
INTRODUCTION
The etiologies of malignant biliary obstruction (MBO)
are known to be variable, including pancreatic cancer
Correspondence to: Bing HU, Department of Endoscopy, Eastern
Hepatobiliary Hospital, Second Military Medical University, No. 225
Changhai Road, Shanghai 200438, China. Email: drhubing@aliyun.com
Conflict of interest: None.
C 2016 Chinese Medical Association Shanghai Branch, Chinese
Society of Gastroenterology, Renji Hospital Affiliated to Shanghai
Jiaotong University School of Medicine and John Wiley & Sons
Australia, Ltd
716
doi: 10.1111/1751-2980.12429
stricture (3.446 mm, 95% confidence interval [CI]
3.356–3.536 mm) after the endoscopic biliary RFA.
The overall survival time was 9.62 months, with
pooled 30-day, 90-day and 2-year mortality rates of
2% (95% CI 0.5–5.9%), 21% (95% CI 5–37%), and
48% (95% CI 37–59%), respectively. The pooled rate
of adverse events was 17% (95% CI 10–25%), and
most complications were mild and managed conser-
vatively. Severe adverse events occurred in three pa-
tients (two deaths due to hemobilia and one with
partial liver infarction).
CONCLUSIONS: Endoscopic biliary RFA is effec-
tive and generally safe in the management of
unresectable biliary malignancies, and may improve
patients’ overall survival. Prospective, randomized
controlled studies are required to further support
the results.
and bile duct carcinoma. Obstructive jaundice usually
occurs at the advanced stage of biliary malignancy
when radical resection is no longer a treatment
option.1 Therefore, endoscopic therapy (endoscopic
biliary drainage in combination with stent placement)
is considered a treatment of choice for MBO, which
has been proven to be effective in over 80% of the
cases, with a survival benefit and low morbidity
compared with conventional surgery.2,3
Endoscopic biliary stent placement has been found to
be associated with certain adverse events including
Journal of Digestive Diseases 2016; 17; 716–724
recurrent sepsis, stent occlusion and migration.4 In
addition, tumor ingrowth or overgrowth may compro-
mise the long-term patency of self-expandable metal
stents (SEMS). During the last decades, endoscopic
biliary radiofrequency ablation (RFA) has been intro-
duced and applied to maintain stent patency through
the ablation of tumorous tissues and regaining bile
flow.4,5
RFA has been used for the treatment of liver malig-
nancy since the 1990s.6,7 This technology has also
been applied in treating colonic and esophageal
diseases,8,9 as well as a potential palliative treatment
option for malignant biliary strictures5,10. Heat
produced by RFA using a high-frequency alternating
current results in coagulative necrosis of tissues that
are in contact with the probe and subsequently
reduces the size of tumor or its overgrowth as well as
hyperplastic benign biliary epithelium. Previous
studies1,5,10–16 have evaluated the technical success
rate, safety and impact of endoscopic biliary RFA on
patients’ survival, showing that RFA combined with
SEMS placement is beneficial and safe in treating
MBO although its application is limited due to the
heterogeneity of the studies and a lack of randomized
controlled trials. The aim of this systematic review and
meta-analysis was to evaluate the efficacy and safety of
RFA in the management of MBO and its impact on
patient’s survival.
MATERIALS AND METHODS
Search strategy
A literature search of the Cochrane Library, PubMed
and EMBASE databases was conducted to identify arti-
cles evaluating the efficacy of endoscopic biliary RFA
in the management of MBO which were published
up to 4 July 2015. The following search terms were
used: ‘endoscopic’ AND (‘radiofrequency ablation’
OR ‘RF ablation’ OR ‘RFA’) AND (‘malignant biliary
obstruction’ OR ‘malignant biliary stricture[s]’ OR
‘MBO’). The literature search was restricted to human
studies and English-language articles. The references
of the identified articles were also reviewed for
additional relevant studies.
Inclusion and exclusion criteria
The studies included in the systematic review and
meta-analysis were observational studies investigating
the efficacy and safety of endoscopic RFA for the
management of MBO. Inclusion criteria were: (i)
observational human studies (either retrospective or
C 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of
Medicine and John Wiley & Sons Australia, Ltd
Endoscopic biliary RFA for MBO 717
prospective) including patients with unresectable
malignant biliary strictures, such as cholangiocarci-
noma and pancreatic cancer, who had a life
expectancy of over 3 months; (ii) patients were treated
with endoscopic biliary RFA; (iii) patient outcomes
including technical success, median overall survival,
2-year survival rate and complications were analyzed;
(iv) studies included the comparison of RFA with
non-RFA; and (v) all patients had provided their
informed consent prior to their inclusion in the study.
Exclusion criteria were: (i) case reports, review articles,
meta-analyses, letters, comments and conference
abstracts; (ii) studies on cell lines or animals; (iii)
studies investigating other than the efficacy and safety
of endoscopic biliary RFA in the treatment of MBO,
such as guidelines; and (iv) studies on interventions
that were not related to therapeutic biliary endoscopy.
Data extraction
The following information was extracted from each
study: first author, year of publication, country of
populcation studied, participants’ age and sex, study
size and number of cases, etiologies, classification
and the length of MBO, number and success rate of
endoscopic biliary RFA, patient outcomes and the
procedure-related complications. Technical success of
RFA was defined as the ability of accurate positioning
and deployment of the RFA probe over the stricture,
and performing ablation successfully without immedi-
ate adverse events. Data extraction was performed by
two authors (Xiao ZHENG and Ye Chen WU) indepen-
dently. Any disagreement was resolved by consensus.
Quality assessment
The GRADE Profiler 3.6 (GRADE Working Group;
www.gradeworkinggroup.org)17 was applied to assess
the quality of the included studies. Randomized con-
trolled trials were regarded as high-quality evidence,
whereas observational studies as low-quality evidence.
Statistical analysis
Statistical analyses were performed using the StataSE
12.0 (STATA Corporation, College Station, Texas,
USA) and SPSS 18.0 (IBM, Armonk, NY, USA). The
pooled proportions of 30-day, 90-day and 2-year sur-
vival rates and complication rates were adopted as
the main indices for this meta-analysis. The meta-
analytic 95% confidence interval (CI) and pooled pro-
portions were obtained using a random effects model.
The heterogeneity of the pooled data was assessed
using the Cochrane’s Q-test and was quantified with
718 X Zheng et al. Journal of Digestive Diseases 2016; 17; 716–724

I2 statistics. I2 > 50% was considered to indicate

substantial heterogeneity. P < 0.05 was regarded as
statistically significant.

RESULTS

Characteristics of the studies

A total of 1 735 articles were identified through the

initial literature search. After the titles and abstracts
were reviewed for revelance, 1 700 records were
excluded; among these 1 700 articles, 696 were not
relevant to the research topic, 445 were review articles,
271 were case reports and the other 288 were not pub-
lished in English. The full-texts of the remaining 35 ar-
ticles were then retrieved; 26 were further excluded
because they were either duplicated (n = 18) or the
number of patients did not meet the inclusion criteria
(n = 8). Nine eligible studies1,5,10–16 including 263 pa-
tients were finally included in the qualitative and
quantitative analyses. The flowchart of study selection Figure 1. Flow diagram of study selection.
is depicted in Fig. 1. Most articles were retrospectively
designed except one open-label pilot study. The mean
age of the patients was 68.3 years, and 52.5% (138/
the location, length and diameter of bile duct stricture.
263) were males. The indications for RFA were cholan-
The endoscopic biliary RFA was performed over a
giocarcinoma or bile duct cancer (n = 173, 65.8%),
0.035-inch guidewire using an 8 F (2.6 mm), 1.8-
followed by pancreatic cancer (n = 77, 29.3%), meta-
meter-long bipolar catheter, which is compatible with
static cancer (n = 4, 1.5%), gallbladder cancer (n = 4,
the standard (a working channel of 3.2 mm) side-
1.5%), hepatocellular carcinoma (n = 3, 1.1%), gastric
viewing endoscopes (Olympus TJF-160, TJVF-160,
cancer (n = 1, 0.4%) and intraductal papillary mucin-
TJVF-180 and TJF-260; or Fujinon EVE200). The RFA
ous neoplasm (n = 1, 0.4%). Among those with chol-
probe has two ring electrodes with the distal electrode
angiocarcinoma and bile duct cancer, 37.6% (65/173)
at 5 mm proximal to the leading edge. It provides
had a Klatskin tumor. The mean length of MBO was
local coagulative necrosis over a 2.5-cm length. The
19.41 mm. The characteristics of the nine included
RFA probe was advanced over a guidewire to the stric-
studies are summarized in Table 1.
ture of interest under the guidance of fluoroscopy.
Energy was delivered at 7–10 W for 1–2 min with a
rest period of 1–2 min before moving the catheter.
Quality assessment of the studies
Depending on the length of the stricture, sequential
Following quality assessment, all the nine studies were applications were made without significant overlap
rated as low or moderate quality (Table 2). Quality of the treated areas. Biliary stents (plastic stents or
was regarded as more than risk of bias in GRADE; SEMS, uncovered or fully covered) were deployed af-
therefore, it might have been compromised by impre- ter RFA. There was no statistically significant associa-
cision, inconsistency, indirectness of study results and tion between the type of stent used and the
publication bias. In addition, our confidence in an improvement of the biliary stricture (P = 0.18). Com-
estimate of effect could have been increased by several pared with patients who were treated with SEMS,
other factors. those treated with plastic stents were less likely to
have a survival benefit to pancreatic cancer (log–
rank = 0.032, P = 0.035) than to cholangiocarcinoma
Technical features of RFA (log–rank = 0.562).1 The technical success rate of the
endoscopic biliary RFA was 96.8% (95% CI
All the endoscopic RFA procedures were performed 95.5–98.1%). The median RFA session was 1.597
under conscious sedation or general anesthesia. (95% CI 1.529–1.665). The technical details of the
Cholangiogram was routinely performed to identify procedures are listed in Table 3.

C 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of
Medicine and John Wiley & Sons Australia, Ltd
 Table 1. Summary of patients’ characteristics and outcomes for malignant biliary obstruction (MBO) by radiofrequency ablation (RFA)
Baseline mean Technical Median
Authors Study Patients Mean age Male sex Etiology length of success, survival Median Complications,

Medicine and John Wiley & Sons Australia, Ltd

(publication year) Country design (n) (years) (%) (n) MBO (mm) n (%) (months) RFA n (%)
5
Steel et al. (2011) United Open-label 22 70 50.0 PC (16), CCA (6) 37 21 (95.5) - 2 4/21 (19.0)
Kingdom pilot study
Figueroa-Barojas USA Retrospective 20 65.3 75.0 CCA (11), PC (7), 15.2 20 (100) NM NM 5 (25.0)
et al.11 (2013) Metastatic GC (1),
Journal of Digestive Diseases 2016; 17; 716–724

IPMN (1)
Tal et al.13 (2013) Germany Retrospective 12 70 58.3 CCA (9), Metastatic NM 12 (100) 6.4 1 7 (58.3)
GC (1), GBC (2)
Alis et al.15 (2013) Turkey Retrospective 17 62.3* 70* CCA (17) 20 10 (58.8) NM 3 3/10 (30.0)
Sharaiha et al.10 USA Retrospective 26 65.5 69.2 CCA (18), PC (8) 20.4 26 (100) 5.9 NM 5 (19.2)
(2014)
Dolak et al.12 (2014) Austria Retrospective 58 75† 53.4 BDC (51), PC (4), NM 58 (100) 10.6 1.4 11 (19.0)
HCC (3)
Strand et al.14 (2014) USA Retrospective 16 64.3 62.5 CCA (16) NM NM 9.6 1.19 NM
Sharaiha et al.1 USA Retrospective 69 66.1 31.9 CCA (45), GC (1), 14.3 69 (100) 11.46 1.4 7 (10.1)
(2015) PC (19), Metastatic
colon cancer (2),
GBC (2)
Kallis et al.16 (2015) United Retrospective 23 68.9 52.2 PC (23) NM 23 (100) 7.5 NM 1 (4.3)
Kingdom
*Calculated based on patients who successfully undergo RFA. †Median value. BDC, biliary duct cancer; CCA, cholangiocarcinoma; GBC, gallbladder cancer; GC, gastric carcinoma; HCC,
hepatocellular carcinoma; IPMN, intraductal papillary mucinous neoplasm; NM, not mentioned; PC, pancreatic carcinoma.
Endoscopic biliary RFA for MBO

C 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of
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720 X Zheng et al. Journal of Digestive Diseases 2016; 17; 716–724

Table 2. Summary of quality assessment of each study

Authors (publication year) Mortality, % (n/N) Relative effect (95% CI) Quality of the evidence (GRADE)†
Steel et al.5 (2011) 9.5 (2/21) NM Low
Figueroa-Barojas et al.11 (2013) 0 (0/20) NM Low
Tal et al.13 (2013) 58.3 (7/12) NM Low
Alis et al.15 (2013) 10.0 (1/10) NM Low
Sharaiha et al.10 (2014) 7.7 (2/26) HR 0.29 (0.11–0.76) Moderate
Dolak et al.12 (2014) 100 (58/58) NM Low
Strand et al.14 (2014) 7.7 (1/13) HR 0.539 (0.218–1.328) Low
Sharaiha et al.1 (2015) 24.6 (17/69) NM Low
Kallis et al.16 (2015) 100 (23/23) OR 1.56 (0.37–6.63) Moderate
17
†Working group grades of evidence: high quality, further research is very unlikely to change our confidence in the estimate of effect;
moderate quality, further research is likely to have an important impact on our confidence in the estimate of effect and may change the
estimate; low quality, further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to
change the estimate; very low quality, we are very uncertain about the estimate.
CI, confidence interval; HR, hazard ratio; NM, not mentioned; OR, odds ratio.

The improvement in MBO after endoscopic biliary
RFA
There was a significant improvement in bile duct
stricture after the endoscopic biliary RFA. The mean
diameter at the site of biliary stricture was
1.189 mm (95% CI 1.036–1.343 mm) before RFA
and 4.635 mm (95% CI 4.535–4.735 mm) after
RFA, with an increase of 3.446 mm (95% CI
3.356–3.536 mm) after RFA. The median duration
of stent patency was 7.644 months (95% CI
6.874–8.414 months).
Complications
Significant adverse events were reported in three
studies.11–13 The pooled rate of adverse events was
17% (95% CI 10–25%). Dolak et al.12 reported one
case of post-RFA partial liver infarction in a patient
with Bismuth type IV cholangiocarcinoma, which was
probably caused by thermal injury of a segmental liver
artery and was managed conservatively. Tal et al.13
reported three cases of post-procedure biliary bleeding
that had occurred 4 to 6 weeks after the intervention;
among them, two died due to hemorrhagic shock,
while the other was successfully managed by the
insertion of an uncovered SEMS. Figueroa-Barojas
et al.11 reported one case of severe post-procedural
cholecystitis requiring percutaneous drainage. Mild
complications included pain (11%, 95% CI 0.9–31%),
cholangitis (8%, 95% CI 1–14%), cholecystitis (4%,
95% CI 1–7%), rigor (6%, 95% CI 1–14%), bleeding
(2%, 95% CI 0–5%) and post-endoscopic retrograde
cholangiopancreatography pancreatitis (2%, 95% CI
0–5%), but all were managed conservatively.
Overall survival and stent patency
The pooled 30-day, 90-day and 2-year mortality were
2% (95% CI 0.5–5.9%), 21% (95% CI 5–37%) and

Table 3. Technical details of radiofrequency ablation (RFA)

Authors Time per energy Energy Mean stricture diameter Mean stricture diameter Median stent
(publication year) delivery (min) (watts) before RFA (mm) after RFA (mm) patency (months)
Steel et al.5 (2011) 2 7–10 0* 4* 3.8
Figueroa-Barojas 2 7–10 1.7 5.2 NM
et al.11 (2013)
Tal et al.13 (2013) 1–1.5 8–10 NM NM NM
Alis et al.15 (2013) 2 10 1.5 5 9
Sharaiha et al.10 (2014) 1.5–2 7–10 1.6 4.5 NM
Dolak et al.12 (2014) 2 7–10 NM NM 5.7
Strand et al.14 (2014) 1.5 7 or 10 NM NM NM
Sharaiha et al.1 (2015) 1.5 8 NM NM NM
Kallis et al.16 (2015) 2 10 NM NM 15.7
*Median value. NM, not mentioned.

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Journal of Digestive Diseases 2016; 17; 716–724 Endoscopic biliary RFA for MBO 721

Figure 2. Forest plots to show the pooled mortality at (a) 30 days, (b) 90 days and (c) 2 years. ES, effect size.

C 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of
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722 X Zheng et al.
48% (95% CI 37–59%), respectively (Fig. 2). No sub-
stantial heterogeneity was found in the 30-day, 90-day
and 2-year mortality. Publication bias was not
evaluated using the funnel plot because fewer than
nine studies were included in each analysis. A sum-
mary of the quality assessment of analysis and
outcomes is shown in Table 4. The pooling of the
overall survivals from each study was impossible
because survival was expressed as either mean or
median. The overall survival time was 9.62 months
(95% CI 9.33–9.90 months).
DISCUSSION
For patients with pancreaticobiliary carcinoma,
curative surgical resection with negative histological
margins provides the best chance of survival and is
the current first-line treatment. However, most
patients with MBO are diagnosed at an advanced stage
of the disease and only 30% of them are indicative for
surgery, with reported post-surgery 5-year survival
rates of 25–30%.18,19 In this study the most
commonly reported etiology for MBO was cholangio-
carcinoma or bile duct cancer, followed by pancreatic
carcinoma. It appeared that endoscopic biliary
RFA was mostly applied in patients with extrahe-
patic cholangiocarcinoma, with a length of around
2 cm.
Chemotherapy, radiotherapy and minimally invasive
endoscopic therapy are mainly considered for patients
with unresectable pancreatic or bile duct carcinoma.20
Endoscopic biliary stenting and photodynamic
therapy (PDT) have been proven to be effective in
improving the overall survival rate and are recom-
mended for unresectable MBO.21,22 Endoscopic
biliary RFA has recently been emerged as another
minimally invasive palliative therapy for biliary
malignancies. The outcomes of percutaneous RFA for
primary or secondary intrahepatic malignancies were
Table 4. Summary of quality assessment of analysis
Outcomes (follow-up) Pooled mortality, % (n/N)
30 days (5 studies) 1.5 (2/132)
90 days (3 studies) 20.9 (19/91)
2 years (2 studies) 48.1 (39/81)
†Working group grades of evidence:17 High, further research is very unlikely to change our confidence in the estimate of effect; moderate,
further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; low, further
research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; very low, we
are very uncertain about the estimate.
C 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of
Journal of Digestive Diseases 2016; 17; 716–724
comparable to those of biliary RFA. Compared with
PDT, endoscopic biliary RFA requires lower capital
expenditure and less preparation of the patients, and
avoids the side effects of photosensitization.14,23 In
this meta-analysis endoscopic biliary RFA achieved a
high technique success rate of 96.8% (95% CI
95.5–98.1%) in patients with MBO. Hilar cholangio-
carcinoma, significant comorbidities and failed deep
bile duct cannulation appeared to be the factors
precluding a successful endoscopic biliary RFA, which
was shown in a case series by Alis et al.15 reporting
that endoscopic biliary RFA could not be performed
in seven of the 17 patients recruited. Three with
Bismuth type II or III hilar cholangiocarcinoma were
considered unsuitable for the placement of the RFA
probe. RFA could not be performed in two patients
who had developed severe respiratory distress during
the procedure due to significant comorbidities, and
in another two patients due to failed deep bile duct
cannulation resulting from severe fibrosis of the
major papilla. However, most of the studies included
in this meta-analysis were retrospectively designed.
Therefore, prospective, randomized clinical trials are
warranted to systematically study the risk factors for
failed endoscopic RFA in the management of MBO.
It has been suggested that the median survival of
patients with MBO who achieved optimal biliary
drainage may be longer than in those who did not.24
Intraductal RFA can induce local coagulative necrosis
of the tumorous tissues5 and maintain stent patency
as well as optimal biliary drainage. In addition, RFA
may enhance the local inflammatory responses and
trigger anti-tumor activity of the T cells,25 all of which
may eventually improve the patient survival. Kallis
et al.16 recently revealed a median survival of 226 days
in patients who underwent endoscopic RFA compared
with 123.5 days in the control group (P = 0.010). RFA
was an independent predictor of survival at 90 and
180 days in multivariate analysis. This study showed
that patients’ overall survival after treated with
Quality of the evidence (GRADE†)
Low
Low
Low
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Journal of Digestive Diseases 2016; 17; 716–724
endoscopic RFA was 9.6 months and the pooled
30-day, 90-day and 2-year mortality was 2% (95%
CI 0.5–5.9%), 23% (95% CI 5–37%) and 46%
(95% CI 37–59%), respectively. The survival benefit
of endoscopic RFA for MBO could not be further con-
firmed in this study due to the lack of randomized
controlled clinical trials. However, our results support
the view that endoscopic RFA is an effective adjuvant
therapy in patients with advanced biliary and pancre-
atic malignancies. More prospective, randomized
controlled studies are needed to further explore the
effectiveness and benefits of endoscopic RFA on the
survival of patients with MBO.
We also showed that endoscopic biliary RFA was
generally safe in treating of MBO and most of the
adverse events reported were mild and were managed
conservatively. For endoscopic biliary RFA using the
Habib EndoHBP catheter (Emcision UK, London,
UK), the tissue effect of different power and time
settings has been previously studied in an ex vivo
porcine model, showing that the dimension of
coagulative area was 22 mm × 9 mm at a typical
setting of 10 W applied for 60–90 s.13 When the RFA
catheter is positioned correctly against the tumorous
tissues the depth of ablation is limited to 5 mm, which
may prevent deep ablation as well as ductal perfora-
tion.15 However, severe adverse events have also been
reported in some studies, including two deaths related
to significant biliary hemorrhage that occurred a few
weeks after the procedure. Although only 3% of the
study population developed biliary bleeding, we
believe that the early detection of bleeding is essential
for appropriate management and the reduction of
procedure-related mortality. In addition, our experi-
ence advocates a prophylactic pancreatic duct stenting
before biliary RFA in patients with cholangiocarci-
noma located in the lower common bile duct, which
may be effective in preventing severe post-procedure
acute pancreatitis.
Some limitations of this study should be taken into
account. First of all, most of the studies included in
our study were retrospectively designed, and prospec-
tive, randomized controlled clinical trials were lack-
ing. Second, the sample size was small in most of
the included studies, which could have compromised
the statistical power of this study. Finally, detailed
information with regard to the location of MBO was
not observed in most of the included articles, making
it impossible for us to compare the effectiveness and
safety of endoscopic RFA in hilar and non-hilar biliary
malignancies, respectively.
C 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of
Medicine and John Wiley & Sons Australia, Ltd
Endoscopic biliary RFA for MBO 723
In conclusion, we found in this study that endoscopic
biliary RFA was effective and generally safe in the man-
agement of MBO. Further prospective, randomized
controlled clinical trials are needed to study the
benefits of endoscopic RFA on patient survival as well
as the risk factors of procedure-related adverse events.
ACKNOWLEDGMENTS
This study was partially supported by funding from the
2015 Shanghai Outstanding Medical Academic Leader
Program (no. 2015-83). The authors would like to thank
the statisticians from the Department of Statistics,
Second Military Medical University (Shanghai, China),
for their assistance on statistics.
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