Chemical Ablation of the Gallbladder with Acetic Acid

Abstract

PURPOSE: Chemical ablation of the gallbladder may be a useful alternative to surgery for inoperable disease. The purpose of this study was to investigate the feasibility of chemical ablation of the gallbladder with acetic acid in a canine model. MATERIALS AND METHODS:Five beagle dogs underwent percutaneous transhepatic cholecystostomy. Percutaneous occlusion of the cystic duct was performed with use of n-butyl cyanoacrylate (NBCA) and coils. After confirmation of occlusion of the cystic duct, sclerotherapy of the gallbladder was performed with 4 -7 mL of 50% acetic acid through the drainage catheter. Acetic acid was retained for 20 minutes with intermittent position change. The drainage catheter was removed immediately after sclerotherapy. The dogs were euthanized 8 weeks after the procedure. The gallbladders and adjacent organs were evaluated grossly as well as microscopically.RESULTS: All dogs survived without serious complications during the experimental period. Sclerotherapy was technically successful in all dogs. Gross specimens of the gallbladder showed shrinkage and fibrotic change without retention of any bile, mucus, or pus. Histologic examinations from the body and fundus of the gallbladder demonstrated complete ablation of the mucosa. However, the neck region of the gallbladder near the cystic duct, where NBCA and coils for cystic duct occlusion were located, had focal areas of remnant or regenerating mucosa.CONCLUSIONS: Chemical ablation of the gallbladder with 50% acetic acid was effective and safe. Complete ablation was achieved in the majority of gallbladder mucosa except for a small portion located in the gallbladder neck.

Time course of histopathological changes after bleomycin sclerotherapy in rabbit gallbladders as a model for simple hepatic cysts

“…The late epithelial regeneration by a single layer of flat cells after chemical ablation of the gallbladder is like that reported in animal experiments with different sclerosants (25)(26)(27). In animal models of bleomycin-induced pulmonary fibrosis, alveolar epithelial regeneration is hypothesized to an important repair process following lung injury, which is regulated by various cellular and physiological mechanisms (34).…”

“…Furthermore, the anatomical site of the rabbit gallbladder is convenient for making surgical procedures and is independent of the digestive system, such that its function and survival are not affected after operation. The practical basis of the rabbit gallbladder model is derived from animal experiments of chemical ablation of the gallbladder, with various sclerosants that emerged from the late 1980's to the early 2000's (25)(26)(27). The results of the present study suggest that the animal model of a simple hepatic cyst established by ligating the cholecystic duct and preserving cholecystic vessels is more reliable, operable and repeatable than other reported models of cystic diseases.…”