Endobiliary Radiofrequency Ablation in Cholangiocarcinoma: Current Evidence and Future Perspectives

Cholangiocarcinoma (CCA) is an aggressive malignancy associated with malignant biliary obstruction and it has poor overall survival. Most patients present with unresectable disease which limits curative treatment options and highlights the need for effective palliative therapies. Endobiliary radiofrequency ablation (RFA) has emerged as a minimally invasive technique aimed at reducing intraductal tumor burden, improving biliary drainage, and potentially prolonging survival. Recently, multiple randomized controlled trials, retrospective studies, and meta-analyses have evaluated the role of endobiliary RFA in patients with CCA, with mixed results. Available evidence suggests that RFA may provide a survival benefit in selected patients. However, its effects on stent patency and quality of life remain inconsistent across studies. Current data also demonstrate an overall acceptable safety profile. In this review, we summarize the procedural techniques, currently available evidence, adverse events, patient selection considerations, guideline recommendations, and future directions regarding the use of endobiliary RFA in CCA.