Percutaneous Endobiliary Radiofrequency Ablation (PERFA) for Unresectable Cholangiocarcinoma

Cholangiocarcinoma (CCA) is an aggressive malignancy often diagnosed at an advanced stage, precluding curative resection. In such patients, palliative interventions to relieve biliary obstruction are critical. Endobiliary radiofrequency ablation (RFA) using the Habib™ EndoHPB probe has been explored as an adjunct to improve biliary patency, though its percutaneous application and complication rate remain underexplored.

We retrospectively reviewed eight patients (mean age: 59.9 ± 6.2 years; four males, four females) with unresectable intrahepatic/perihilar CCA who underwent percutaneous endobiliary RFA between January 2022 and June 2025. Outcomes included technical and clinical success, laboratory trends, adverse events, and interventional radiology (IR) service utilization.

Technical success was achieved in all patients (100%). Clinical success, defined as ≥50% bilirubin reduction from baseline within one month, and either symptom resolution within 14 days or improvement in biliary obstruction-related clinical parameters, was observed in seven patients (87.5%). No major procedure-related adverse events were noted, including vascular complications, despite endobiliary ablation. Following RFA, mean total bilirubin decreased from 5.5 ± 7.6 mg/dL to 2.7 ± 2.7 mg/dL at one month (p = 0.187). Aspartate aminotransferase (AST) declined from 85.9 ± 48.1 U/L to 59.7 ± 39.5 U/L (p = 0.005), and alanine aminotransferase (ALT) decreased from 104.7 ± 76.2 U/L to 56.1 ± 50.8 U/L (p = 0.054). The frequency of drain exchanges improved, with intervals extending from 1-3 weeks pre-RFA to 4-8 weeks post-RFA. Over a mean follow-up of 398.6 ± 562.3 days, three patients (37.5%) achieved drain internalization, while two deaths were attributed to disease progression.

Percutaneous endobiliary RFA with the Habib probe is safe, technically feasible, and associated with favorable laboratory and clinical outcomes in unresectable CCA.