Impact of Radiofrequency Ablation on Uncovered Metal Stent Patency in Malignant Biliary Obstruction from Pancreatic Cancer

Background and study aims: Pancreatic ductal adenocarcinoma (PDAC) with malignant biliary obstruction is frequently unresectable and carries a median survival of less than one year. Uncovered self-expandable metal stents (UCSEMS) are standard for biliary decompression but are limited by tumor ingrowth. Temperature-controlled endobiliary radiofrequency ablation (TC-RFA) has been proposed to prolong stent patency. We evaluated the efficacy and safety of TC-RFA followed by UCSEMS compared with UCSEMS alone for PDAC-related biliary stricture. Patients and methods: In this single-center study, PDAC patients were prospectively treated with TC-RFA plus UCSEMS and compared with a retrospective cohort treated with UCSEMS alone. The primary outcome was time to recurrent biliary obstruction (TRBO) within six months. Secondary outcomes included technical and clinical success, adverse events (AEs), surgical resection, and mortality.