BACKGROUND Malignant biliary tumors are uncommon and usually diagnosed following malignant biliary obstruction. 1 Surgical resection is currently the only potential curative treatment for early recognition and diagnosis. However, a majority of patients present late in the course of disease with only 20%-40% resectable cases due to the advanced tumor stage at the time of diagnosis, and of these potentially resectable tumors, R 0 resection is not always achieved. 2 Therefore, placement of biliary stents is typically chosen as palliative management for biliary decompression with an estimated life expectancy of approximately 3-6 months. 3,4 Compared with surgical interventions, biliary stents offer shorter durations

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Background This study aimed to evaluate the acute and subacute effects of irreversible electroporation (IRE) on normal common bile ducts (CBDs) in a rabbit model. Methods Cell susceptibility to IRE was assessed in vitro with cholangiocarcinoma and normal cell lines at varying voltages. The distributions of electric field and temperature were evaluated with a two-dimensional simulation model of common bile duct. In vivo bile duct IRE ablation was performed in 28 adult New Zealand rabbits. Liver function assessments and cholangiography were performed post-IRE to evaluate biliary complications. The biliary tract was extracted en bloc and histopathological analyses were performed using hematoxylin-eosin (H&E) and Masson trichrome (MT) staining, and terminal deoxynucleotidyl transferase-mediated nick-end labeling (TUNEL) assay. Results Different cells showed different susceptibility to the effect of IRE, cancer cell line HUCC-T1 was the least sensitive to IRE. Simulations predicted the distributions of electric field and temperature during IRE process, and the maximum temperature of tissue was below 43°C. In all animals, biliary dilatation and stricture were observed in 4/28 animals respectively by postoperative days 7, 14, and 28. H&E staining revealed complete cell death with inflammatory infiltration, edema, and hemorrhage. Bile duct epithelial recovery was completed between post-IRE days 7–28. Conclusions The normal CBD retains the lumen wall integrity and function following IRE with immediate periductal placement of the electrode. However, the parameters of cholangiocarcinoma IRE ablation need to be determined more precisely to ensure the treatment efficacy and reduce the risk of collateral damage.