Endobiliary radiofrequency ablation (RFA) for bile duct cancer uses heat inside a narrowed bile duct to destroy tumour tissue before a stent is placed to keep bile flowing. In a 2026 multicentre study of 336 Japanese patients with unresectable extrahepatic cholangiocarcinoma, patients without distant metastases who received RFA lived a median of 527 days, compared with 300 days for those who had a stent alone. Patients who had two or more RFA sessions had the longest survival.
Drawing on the Japanese study in Endoscopy International Open, a study from University Hospital Bonn in Germany, a meta-analysis of five randomised trials and guidance from the UK's National Institute for Health and Care Excellence (NICE), this article explains how the procedure works, who it is for, the key numbers, what to expect and how side effects are managed.
Treatment status · The catheter used for endobiliary RFA has been in clinical use in Japan since October 2019 and is also used in Europe. NICE recommends using it within research so that more data can show which patients benefit most. The Japanese figures come from a retrospective analysis of records from several hospitals. This is general information, not a treatment recommendation.
Burning tumour tissue from inside the bile duct
Cancer of the bile ducts outside the liver (extrahepatic cholangiocarcinoma) often blocks the flow of bile, causing jaundice, itching and fever. When surgery is not possible, doctors usually place a stent (a small tube) in the duct during endoscopy and continue with chemotherapy. As the tumour grows, however, the stent can become blocked and may need to be replaced several times.
In endobiliary RFA, a thin radiofrequency catheter is passed to the narrowed segment during endoscopic retrograde cholangiopancreatography (ERCP). Radiofrequency energy heats and destroys the tumour tissue, widening the passage. A stent is then placed, or tumour tissue growing inside an existing stent is ablated to reopen it. The principle is the same as needle RFA for liver or lung tumours; the difference is that the heating catheter works from inside the bile duct.
| Item | Stent alone | RFA followed by stent |
|---|---|---|
| Aim | Reopen the duct so bile can drain | Reopen the duct and shrink the blocking tumour tissue with heat |
| Method | Plastic or metal stent placed by ERCP | Ablation with an RFA catheter during ERCP, then stent placement |
| If it blocks again | Stent replaced or a second stent added | Tumour inside the stent can be ablated again |
| Effect seen in studies | Relief of jaundice | Relief of jaundice, with longer survival reported |
Based on NICE guidance (HTG731) and a review in the Japanese journal Gastroenterological Endoscopy.
Our RFA overview explains needle-based radiofrequency ablation, and the PELICAN trial of RFA for pancreatic cancer shows how the same energy has been added to chemotherapy in another cancer.
Who is it for?
All the studies reviewed here included patients with extrahepatic cholangiocarcinoma that could not be removed surgically.
- Japanese multicentre study: 336 patients with an endoscopic biliary stent; 121 also received RFA and 215 had a stent alone.
- University Hospital Bonn study: 66 patients on first-line gemcitabine and platinum chemotherapy; 40 also had scheduled, regular RFA and 26 had chemotherapy alone.
In both studies the benefit was clearest in locally advanced disease that had not spread to distant organs. Whether the procedure suits an individual patient depends on the position and length of the narrowing, the width of the duct, liver function and whether there is cholangitis. Our five questions before an RFA consultation can help you prepare.
Results from 336 Japanese patients
The Japanese team (first author Tadahisa Inoue) compared survival separately in patients with and without distant metastases. The figures below are the median overall survival reported in the paper.
| Patient group | With RFA | Stent alone | Statistics |
|---|---|---|---|
| No distant metastases (all) | 527 days | 300 days | P<0.001 |
| No distant metastases + chemotherapy | 611 days | 344 days | P=0.005 |
| No distant metastases, no chemotherapy | 415 days | 282 days | P=0.040 |
| Distant metastases + chemotherapy, multiple sessions | 274 days | 163 days | P=0.044 |
Inoue T, et al. Endoscopy International Open 2026. Because the study is retrospective, the groups were not identical at baseline.
Among patients without distant metastases, those who had RFA lived longer whether or not they received chemotherapy. By number of sessions, survival was 573 days with two or more sessions, 426 days with one and 300 days with none (P=0.002). In patients with distant metastases overall the difference was not clear, but those who had several sessions while on chemotherapy lived longer. Adverse event rates were similar with and without RFA.
The authors concluded that endobiliary RFA significantly improved survival in locoregional extrahepatic cholangiocarcinoma, and that repeated sessions combined with chemotherapy may offer additional benefit in metastatic disease.
German data and a meta-analysis point the same way
Studies from other countries have also reported better outcomes when RFA is added.
| Study | Patients | Main results |
|---|---|---|
| University Hospital Bonn (Scientific Reports 2022) | 66 patients on chemotherapy | Median survival 17.3 vs 8.6 months; progression-free survival 12.9 vs 5.7 months |
| Randomised trial in China (Yang et al.) | Extrahepatic cholangiocarcinoma with stents | Survival 13.2 vs 8.3 months |
| Randomised trial in China (Gao et al.) | Extrahepatic cholangiocarcinoma with stents | Survival 14.3 vs 9.2 months |
| Meta-analysis (Cancers 2024) | 5 randomised trials, 370 patients | Longer stent patency (hazard ratio 0.64); no difference in adverse events |
The Chinese trial figures are as summarised in a 2021 review in Gastroenterological Endoscopy. The first figure is the RFA group.
The Bonn team found that scheduled, repeated RFA during chemotherapy was feasible and reasonably well tolerated. In the meta-analysis, the overall survival benefit varied widely between trials and did not reach statistical significance (hazard ratio 0.62), while trials using plastic stents reported improved survival (hazard ratio 0.42). The authors called for larger randomised trials to confirm the effect.
How the procedure is done
The usual steps below follow the description in NICE guidance. Anaesthesia and length of stay vary between hospitals.
| Step | What happens |
|---|---|
| Sedation | The procedure is done under sedation |
| Mapping | An ERCP endoscope is passed into the duodenum, and X-ray imaging shows the length, width and position of the narrowing |
| Ablation | The catheter is guided over a wire across the narrowing, and controlled pulses of radiofrequency energy destroy the tumour tissue, moving along a long stricture step by step |
| Stent | A stent is placed in the widened passage, or a blocked stent is cleared by ablation |
| Repeat | The procedure can be repeated if needed; the Bonn team repeated it at regular intervals during chemotherapy |
Summarised from chapter 2 of NICE HTG731 (formerly IPG794).
Because the endoscope goes in through the mouth, there is no needle puncture or wound on the abdomen. Other image-guided cancer procedures are described in our IVR (interventional radiology) overview.
Side effects and their management
In the Japanese study, adverse event rates were similar in patients with and without RFA, and NICE concluded that the evidence shows no major safety concerns. A Japanese review of many studies reported adverse event rates ranging from 4.2% to 35%, most of them mild.
Symptoms to watch for after the procedure are fever and chills (cholangitis), pain in the upper right abdomen (cholecystitis) and abdominal pain. One Chinese randomised trial reported cholecystitis in 10.3% of the RFA group, and cholangitis was more frequent in the RFA group in the Bonn study. Bleeding and bile duct perforation have been reported rarely. If fever or significant abdominal pain develops after discharge, contact the treating team promptly.
Availability in Japan and abroad
| Region | Status | Basis |
|---|---|---|
| Japan | A bipolar RFA catheter (Habib EndoHPB) was launched in October 2019 and is used in clinical practice; several hospitals published results for 336 patients in 2026 | Gastroenterological Endoscopy review (2021); Endoscopy International Open (2026) |
| United Kingdom | NICE guidance (November 2024) found no major safety concerns and recommends use within research to gather more data on patient selection and quality of life | NICE IPG794 / HTG731 |
| Germany | A university hospital uses regular, repeated RFA alongside chemotherapy and has published its results | Scientific Reports 2022 |
International patients are often not covered by the host country's public insurance, so confirm cost and availability directly with the hospital.
Endobiliary RFA is usually performed by gastroenterologists who specialise in endoscopy, so it is worth asking how many of these procedures the hospital performs each year. Another local treatment used in the pancreas and bile duct region is covered in survival results with NanoKnife (IRE) for pancreatic cancer.
Questions to ask your doctors
- Is endobiliary RFA possible for the position and length of my tumour?
- Can it be combined with my current chemotherapy, and how many sessions at what intervals?
- Will a plastic or a metal stent be used?
- How are cholangitis or cholecystitis managed if they occur?
- How many of these procedures does this hospital perform each year?
Frequently asked questions
What benefit can endobiliary RFA offer for bile duct cancer?
It reopens the blocked duct while shrinking the tumour tissue that causes the blockage. In the Japanese study of 336 patients, median survival in patients without distant metastases was 527 days with RFA, compared with 300 days with a stent alone. It is a local treatment used together with chemotherapy, not instead of it.
How many RFA sessions are needed?
In the Japanese study, patients who had two or more sessions had the longest survival (573 days), compared with 426 days after one session. The number of sessions and the interval are set by the hospital according to the stent and the chemotherapy schedule.
Can it be done during chemotherapy?
Yes. In the Japanese study, patients who also received chemotherapy had a median survival of 611 days versus 344 days, and in the Bonn study patients who added regular RFA during chemotherapy lived 17.3 months versus 8.6 months.
How common are side effects?
In the Japanese study, adverse event rates were similar with and without RFA. Watch for fever and chills (cholangitis) and upper right abdominal pain (cholecystitis), and tell the medical team straight away if they occur.
This article summarises official international sources and research for general information and is not medical advice. Discuss treatment choices with the doctors who have examined the patient.
Sources (checked October 24, 2026)
- Inoue T, Yoshida M, Yamada N, et al. Determinants of survival benefit from endobiliary radiofrequency ablation for extrahepatic cholangiocarcinoma according to tumor stage, systemic therapy, and session number. Endoscopy International Open. 2026. doi:10.1055/a-2900-1143
- Impact of regular additional endobiliary radiofrequency ablation on survival of patients with advanced extrahepatic cholangiocarcinoma under systemic chemotherapy. Scientific Reports. 2022 (University Hospital Bonn).
- The Impact of Radiofrequency Ablation on Survival Outcomes and Stent Patency in Patients with Unresectable Cholangiocarcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cancers. 2024;16(7).
- Inoue T. Current status and perspectives of endoscopic radiofrequency ablation for malignant biliary stricture. Gastroenterological Endoscopy. 2021;63(9):1588-1602. (Japanese-language source)
- NICE. Endoscopic bipolar radiofrequency ablation for malignant biliary obstruction (IPG794). 2024.
- NICE. HTG731: The condition, current treatments and procedure