Intraductal Cooling via a Nasobiliary Tube During Radiofrequency Ablation of Central Liver Tumors Reduces Biliary Injuries

• Published in: American journal of roentgenology (1976) Vol. 204; no. 6; pp. 1329 - 1335
• Main Authors: Felker, Ely R, Lee-Felker, Stephanie A, Ajwichai, Khobkhoon, Tan, Nelly, Lu, David S, Durazo, Francisco A, Raman, Steven S
• Format: Journal Article
• Language: English
• Published: United States 01.06.2015
• Subjects: Aged; Biliary Tract - injuries; Burns, Electric - etiology; Burns, Electric - prevention & control; Catheter Ablation - adverse effects; Catheter Ablation - instrumentation; Catheter Ablation - methods; Endoscopes; Equipment Design; Equipment Failure Analysis; Female; Humans; Hypothermia, Induced - instrumentation; Hypothermia, Induced - methods; Liver Neoplasms - complications; Liver Neoplasms - surgery; Male; Retrospective Studies; Treatment Outcome; percutaneous radiofrequency ablation; chilled water perfusion; central liver masses; endoscopic nasobiliary tube placement; thermal biliary injury
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.14.13788

The objective of our study was to determine the safety and efficacy of intraductal perfusion of chilled 5% dextrose in water (D5W) via an endoscopic nasobiliary tube (NBT) for the prevention of thermal bile duct injury in patients undergoing percutaneous radiofrequency ablation (RFA) of central liver tumors. We performed a retrospective study comparing outcomes of 32 consecutive patients who underwent percutaneous RFA of central liver tumors without intraductal perfusion of chilled D5W (control cohort) and 14 consecutive patients who underwent temporary intraductal perfusion of chilled D5W at 2 mL/s via endoscopic NBT placement before RFA (endoscopic NBT cohort). The primary and secondary outcomes were the rate of biliary complications and local tumor progression, respectively. All patients tolerated the procedures well. There was a significantly lower rate of biliary complications in the endoscopic NBT cohort (0/14 patients, 0%) than in the control cohort (10/32 patients, 31%) (p < 0.03) with a trend toward improved preservation of liver function in the endoscopic NBT cohort (12/14 patients, 86%) compared with the control cohort (20/32 patients, 62%) (p = 0.05). There was no difference in the rate of local tumor progression between the endoscopic NBT cohort (4/19 tumors, 21%) and the control cohort (9/39 tumors, 23%) (p = 1.0). Perfusion of chilled water through an endoscopic NBT helps prevent thermal biliary injury during RFA of central liver tumors without increasing rates of local tumor progression.