Evaluating the tissue effects of balloon-based endobiliary radiofrequency ablation in porcine bile ducts

Inoue, Tadahisa; Yoneda, Masashi

doi:10.1080/02656736.2020.1859627

Cited by 5 publications

(10 citation statements)

References 7 publications

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“…However, RFA often experiences nonuniform ablation due to the physical contact between electrodes and the luminal tissue surface. In other words, the ablation is either insufficient or excessive 14,19,20 . The poor contact of the electrodes with short or irregular biliary strictures may be responsible for ablating normal tissue or inducing partial tissue ablation, which can result in unpredictable or unfavorable clinical outcomes 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Next, ex vivo porcine bile duct tissue was tested with BDA‐assisted laser treatment to confirm the feasibility of the condition identified from previous liver tests. Because of thinner wall of the normal bile duct (≤1.5 mm) rather than the bulky liver tissue, 20 single treatment at 10 W for 12 s (20% reduced irradiation time) was chosen to avoid coagulating the entire tissue wall during the irradiation. First, the BDA was inserted into the bile duct tissue.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have reported that balloon‐based RF and IRE achieved even ablation in the tubular lumen, compared to conventional catheter devices 14–19 . However, both balloon‐based RFA and IRE still suffer from uneven and unpredictable treatment outcomes due to the uneven degree of the electrode‐based energy delivery 16,19,20 …”

Section: Introductionmentioning

confidence: 99%

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Balloon‐assisted laser application for endoscopic treatment of biliary stricture

Lim,

Truong,

Jeong

et al. 2023

Lasers Surg Med

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ObjectivesMalignant biliary stricture is a ductal narrowing of the bile duct that is often diagnosed at an advanced stage, leading to difficulty in resection. The current study aims to evaluate the feasibility of endobiliary laser treatment by quantifying the extent of coagulative necrosis in tissue under various conditions.MethodsEx vivo and in vivo porcine bile tissues were used for endobiliary laser treatment to characterize the dosimetric responses of the tissue to various treatment conditions: power level, irradiation time, and number of treatments. 532 nm laser light was coupled with a balloon‐integrated diffusing applicator (BDA) to deliver the laser light endoscopically for tissue coagulation. The coagulated regions (maximum length and depth) in the treated tissues were evaluated histologically for quantitative comparison.ResultsDosimetric evaluations with ex vivo liver tissue confirmed that both maximum length and depth of coagulative necrosis (CN) increased with applied power and number of treatments. Ex vivo bile duct tests demonstrated that BDA‐assisted laser treatment at 10 W for 12 s reproducibly yielded CN with a length of 5.8 ± 1.6 mm and a depth of 0.6 ± 0.2 mm. In vivo tests presented that endoscopic laser treatment using the BDA created CN on the ductal surface without any perforation. Microscopic examinations revealed that a dense inflammatory cell infiltration and eosinophilic area in the in vivo treated tissue. The extent of CN in the in vivo tissue was 40% longer and 120% deeper (length: 8.1 ± 0.7 mm; depth: 1.3 ± 0.2 mm), compared to that in the ex vivo tissue.ConclusionBDA‐assisted laser treatment could be a feasible option for endoscopic treatment of biliary stricture with uniform ablation at the circumference of bile duct. Further in vivo studies will be performed in a large number of stricture‐developed porcine models to examine both efficacy and safety of the proposed endobiliary laser treatment for clinical translations.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Balloon‐assisted laser application for endoscopic treatment of biliary stricture

Lim,

Truong,

Jeong

et al. 2023

Lasers Surg Med

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show abstract

“…Currently, a balloon catheter-based RFA device that can make full-circle contact with various strictures is being evaluated in animal experiments. 80,82 This device holds much promise, as it has a more stable ablation range and depth than the conventional catheter RFA. With the advent of such next-generation devices in clinical practice, the indications and applicability of endobiliary RFA will continue to expand so that stable ablation and enhanced treatment results for patients can ultimately be achieved.…”

Section: Future Prospects Of Endoscopic Rfamentioning

confidence: 99%

Updated evidence on the clinical impact of endoscopic radiofrequency ablation in the treatment of malignant biliary obstruction

Inoue

Yoneda

2021

Digestive Endoscopy

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Endoscopic biliary radiofrequency ablation (RFA) was recently developed as a novel adjunctive procedure and a promising therapeutic option in patients with malignant biliary obstruction (MBO). RFA can achieve local tumor control, resulting in improved biliary stent patency and a potential survival benefit. However, the efficacy of biliary RFA remains controversial, and previous studies have shown conflicting results. At present, extrahepatic cholangiocarcinoma is considered the condition most effectively treated by biliary RFA, but there is limited research even on this point. Further, limitations of RFA associated with the devices used during the procedure are an important subject of discussion. In addition to further welldesigned clinical trials, development of innovative devices is warranted to investigate and conclusively establish the usefulness of biliary RFA. In this review we summarize the updated evidence regarding the use of endoscopic biliary RFA for MBO and discuss issues that should be addressed in future studies.

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“…To address these issues, we developed a balloon-based endobiliary RFA (balloon-RFA) system and observed that it could achieve a consistent ablation effect without excessive ablation and could be adapted to various lesions, as reported in an ex vivo study 11 , 12 . Another benefit of balloon-RFA is that it allows for the use of a narrower catheter diameter compared to conventional methods.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of balloon-based endobiliary radiofrequency ablation under cholangioscopy guidance in a swine model

Inoue

Kutsumi

Ibusuki

et al. 2021

Sci Rep

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Although endobiliary radiofrequency ablation (RFA) has demonstrated considerable potential for the treatment of biliary strictures, conventional catheter RFA has several limitations. This study aimed to evaluate the feasibility of a novel cholangioscopy (CS)-guided balloon-based RFA procedure in vivo using a swine model. CS-guided balloon-RFA was performed under endoscopic retrograde cholangiography guidance at target temperatures of 60 ℃ or 70 ℃, which were maintained for 60 s. We evaluated the technical feasibility, adverse events, and histological effects associated with the procedure. Twelve sites were ablated in seven miniature pigs. The CS-guided balloon-RFA procedure was technically successful in all cases without any hindrance. Mucosal changes could be detected during RFA, and the ablation area was identified on CS. Necropsy was performed in four pigs on the same day as the procedure: the tissue samples showed coagulative necrosis, and the entire internal circumference of the bile duct was uniformly ablated. The mean lengths of the ablation area in the samples ablated at 60 °C and 70 °C were 20.64 and 22.18 mm, respectively, while the mean depths were 3.46 and 5.07 mm, respectively. The other three pigs were reared and euthanized and autopsied 35 days after the procedure. The site to be ablated had replaced the granulation tissue and fibrotic changes. No adverse events were observed in any case. CS-guided balloon-RFA appears to be a promising option for treating biliary strictures. This preliminary study could pave the way for the evaluation of this procedure in future human clinical trials.

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Evaluating the tissue effects of balloon-based endobiliary radiofrequency ablation in porcine bile ducts

Cited by 5 publications

References 7 publications

Balloon‐assisted laser application for endoscopic treatment of biliary stricture

Balloon‐assisted laser application for endoscopic treatment of biliary stricture

Updated evidence on the clinical impact of endoscopic radiofrequency ablation in the treatment of malignant biliary obstruction

Feasibility of balloon-based endobiliary radiofrequency ablation under cholangioscopy guidance in a swine model

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