Endoscopic Perductal Electrolytic Ablation of the Pancreas: Experimental Studies of Morbidity and Mortality

Abstract

Background: Palliation of pancreatic cancer remains the only option for the majority of patients. Palliative techniques such as surgical bypass and endoscopic retrograde cholangiopancreatography (ERCP) with stenting are not ideal. The ‘ideal’ palliative technique would combine the efficacy of surgery with the minimal complications of an endoscopic procedure. Endoscopically delivered perductal electrolytic ablation of pancreatic lesions has the potential to meet these criteria. Methods: Fifteen pigs were used. The pancreatic duct was cannulated with an electrolysis catheter. Animals were randomised to either: controls, treatment 2-week survivor or treatment 8-week survivor. An electrolytic dose was administered to the treatment animals. Post-operatively, serum amylase and leucocyte count were assessed. Pancreata were histologically examined to detect evidence of acute pancreatitis. Results: Electrolysis was well tolerated. There was no difference in post-operative hyperamylasaemia and leucocyte count between the groups. Histological examination showed inflammation at the ablation site at 2 weeks, by 8 weeks this was replaced by scarring. Conclusion: The results of this study suggest that endoscopic perductal electrolytic ablation of the pancreas is feasible and safe. Biochemical and histological findings indicate self-limiting localised inflammation of the pancreas. This technique may have a role in the palliation of pancreatic cancer and warrants further investigation.

Clinical importance of precursor lesions in the pancreas

“…Laparoscopic pancreatectomy may be used to resect pancreata with PanINs, although the safety and efficacy of the laparoscopic approach needs to be established in further clinical studies . For future therapeutic strategies, we need to develop other nonsurgical methods as well, e.g., endoscopic perductal electrolytic ablation . The bottom line is to target only the affected portions of the gland while preserving as much of the uninvolved parenchyma as possible.…”

“…92 For future therapeutic strategies, we need to develop other nonsurgical methods as well, e.g., endoscopic perductal electrolytic ablation. 93 The bottom line is to target only the affected portions of the gland while preserving as much of the uninvolved parenchyma as possible.…”