Introduction

Among the diagnostic methods for EHCC, cell brush is the conventional method for EHCC diagnosis, but the sensitivity of cell brush and routine biopsy is low. The sensitivity and accuracy of EHCC diagnosis can be improved by single oral choledochoscopy. Radiofrequency ablation is a common and effective treatment for unresectable EHCC, providing local tumor control. Single oral choledochoscopy combined with radiofrequency ablation can improve the positive rate of pathological diagnosis.

Aims & Methods

To investigate the feasibility and safety of treating nonresectable extrahepatic cholangiocarcinoma (EHCC) with single resection combined with radiofrequency ablation (RFA).
A total of 149 patients with suspected extrahepatic cholangiocarcinoma treated in Hangzhou First People's Hospital from January 2013 to January 2023 were reviewed. According to the treatment process, 114 patients were eventually included and divided into two groups (n=48 cases) : Single oral choledochoscopy was performed by ERCP and the lesion tissue was biopsied under direct vision. Intraoperative rapid pathologic examination was performed on the same stage RFA for the patients who were pathologically identified as malignant tumors. Regular times group (n = 66) : first by endoscopic retrograde pancreatic angiography (endoscopic retrograde cholangiopancreatography, ERCP) + cells brush or a single biopsy samples by mouth choledochoscope examination, pathological results to obtain positive line of ERCP + RFA again; The operation success rate, postoperative liver function recovery, average ERCP number, postoperative adverse event incidence, length of hospitalization and cost were compared between the two groups.

Results

1. Patients in both groups successfully completed the RFA, the operation success rate was 100% (114/114).
2. There was no significant difference in the overall incidence of postoperative adverse events between the two groups [39.58% (19/48) vs. 39.40% (26/66),χ2=0.00, P=0.984].
3. There was no significant difference in the proportion of patients with total bilirubin improvement between the two groups [41.67% (20/48) vs. 42.42% (28/66), χ2= 0.32, P=0.750].
4. The average number of ERCP in the same group was significantly lower than that in the conventional group, and the difference was statistically significant (1.00±0.00 times/person vs. 2.64±0.49 times/person, t=0.77, P<0.001).
5. The average length of hospital stay in the same group was significantly longer than that in the conventional group, with statistical significance (8.40±3.63 days vs. 17.47±9.82 days, t=6.21, P<0.001).
6. The average hospitalization cost in the same group was significantly higher than that in the conventional group, and the difference was statistically significant (27718.31±9142.02 yuan versus 49112.76±16153.14 yuan, t=7.38, P<0.001).

Conclusion

Single oral choledochoscopy combined with biopsy and RFA in the diagnosis and treatment of unresectable EHCC can reduce the number of operations and does not increase the incidence of postoperative adverse events, which is a safe and effective method with a high cost-benefit ratio.

References

[1] Le V H, O'Connor V V, Li D, et al. Outcomes of Neoadjuvant Therapy for Cholangiocarcinoma: A Review of Existing Evidence Assessing Treatment Response and R0 Resection Rate [J]. J Surg Oncol, 2021, 123(1): 164-71.
[2] Chen R, Zheng D, Li Q, et al. Immunotherapy of Cholangiocarcinoma: Therapeutic Strategies and Predictive Biomarkers [J]. Cancer Lett, 2022, 546: 215853.
[3] Rizzo A, Ricci A D, Brandi G. Durvalumab: An Investigational Anti-Pd-L1 Antibody for the Treatment of Biliary Tract Cancer [J]. Expert Opin Investig Drugs, 2021, 30(4): 343-50.
[4] Sadeghi S. Infigratinib for Cholangiocarcinoma [J]. Drugs Today (Barc), 2022, 58(7): 327-34.
[5] Vignone A, Biancaniello F, Casadio M, et al. Emerging Therapies for Advanced Cholangiocarcinoma: An Updated Literature Review [J]. J Clin Med, 2021, 10(21).
[6] Jang D K, Kim J, Paik C N, et al. Endoscopic Retrograde Cholangiopancreatography-Related Adverse Events in Korea: A Nationwide Assessment [J]. United European Gastroenterol J, 2022, 10(1): 73-9.
[7] Hollenbach M, Hoffmeister A. Adverse Events in Endoscopic Retrograde Cholangiopancreaticography (Ercp): Focus on Post-Ercp-Pancreatitis [J]. United European Gastroenterol J, 2022, 10(1): 10-1.

Disclosure

The authors declare that there are no conflicts of interest.