Progress in Endobiliary RFA for Cholangiocarcinoma: A Review of Current Evidence and Techniques

Endobiliary radiofrequency ablation (RFA) added to biliary stenting may extend stent patency and palliate symptoms in unresectable extrahepatic cholangiocarcinoma, though study results are heterogeneous.

Does RFA plus stenting improve stent patency and survival versus stenting alone? A recent review of small randomized and observational series reports longer stent patency with RFA plus stenting, though effect sizes vary and a survival advantage remains uncertain.

The endoscopic technique advances a bipolar probe into the malignant stricture and delivers focal thermal coagulation to reduce intraductal tumor burden and delay ingrowth. Pooled safety data show overall adverse-event rates comparable to stenting alone but a reproducible signal for a modestly increased risk of acute cholecystitis, likely when ablation is performed near the cystic duct. Patient selection should avoid ablation when cystic-duct anatomy or gallbladder vulnerability raises risk.

In sum, the current data support cautious, center‑level adoption of endobiliary RFA where endoscopic expertise and multidisciplinary care are available, with protocol standardization and prospective data collection prioritized. Practice should advance incrementally alongside trials and registries to define durable benefit.

Key Takeaways:

• Evidence from aggregated series shows improved stent patency with RFA plus stenting in many cohorts, but heterogeneity prevents definitive conclusions about survival.
• This approach applies mainly to patients with unresectable extrahepatic cholangiocarcinoma who need palliative biliary drainage and have feasible endoscopic access.
• Operational next steps: confirm local availability, discuss in a multidisciplinary forum, standardize protocols, and enroll patients in registries or trials to clarify long‑term outcomes.