Feasibility study of endoscopic thermal coagulation with circumferential laser irradiation for treating esophageal tissue

Jeong, Seok; Bak, Jinoh; Kim, Sung Min; Kang, Hyun Wook

doi:10.1007/s10103-019-02877-3

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…Endoscopic balloon-assisted laser treatment (EBLT) has been introduced for the endoscopic treatment of tubular tissues (e.g., biliary duct and esophagus) by inflating the balloon for tissue expansion and simultaneously irradiating the inner lumen with laser light for thermal ablation and/or coagulation [ 31 , 32 , 33 , 34 ]. A combination of mechanical expansion and cylindrical light emission during EBLT can selectively induce uniform coagulation in a target tissue with minimal thermal injury to the surrounding tissue in a short time (<10 min).…”

Section: Introductionmentioning

confidence: 99%

Feasibility Study on Endoscopic Balloon-Assisted Laser Treatment (EBLT) of Gastroesophageal Reflux Disease (GERD) in In Vivo Porcine Model

Cha

Kim²,

Truong³

et al. 2023

Biomedicines

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Gastroesophageal reflux disease (GERD) has been growing globally, with an increasing burden on the healthcare system due to multiple factors, such as aging and obesity. The current study evaluated the feasibility of endoscopic balloon-assisted laser treatment (EBLT) in a porcine model. GERD was initially developed in three animals via botulinum toxin injection into lower esophageal sphincter (LES). A week after the injection, the EBLT was performed on the GERD-developed models (control = 1 vs. treated = 2). A dose of 30 W of 980 nm laser light was endoscopically applied for 90 s to the LES. Both endoscopic ultrasound and manometry were performed before and after the EBLT. After 12 weeks, esophageal tissues were extracted and prepared for histological analysis. The maximum mucosa temperature was below 50 °C during the EBLT. Compared to control, the treated group yielded thicker and shorter LES muscle layers and maintained LES pressure. Through histology, the EBLT reinforced the muscularis layer with preserved mucosa and mild remodeling of the intermuscular collagen in the LES. The current study demonstrated the feasibility of EBLT as a new endoscopic approach for GERD. Further studies will examine the EBLT in a larger number of animals to warrant efficacy and safety for clinical translations

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Section: Introductionmentioning

confidence: 99%

Feasibility Study on Endoscopic Balloon-Assisted Laser Treatment (EBLT) of Gastroesophageal Reflux Disease (GERD) in In Vivo Porcine Model

Cha

Kim²,

Truong³

et al. 2023

Biomedicines

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“…Common endoscopic therapies for esophageal diseases include endoscopic dilation (PD), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and radiofrequency balloon ablation [8][9][10][11]. In particular, a balloon catheter-integrated diffusing applicator (BCDA) has recently been developed as a potential therapeutic device for treating tubular tissue structures effectively [12][13][14]. The combined treatment with balloon dilation and cylindrical thermal coagulation can expand the tubular tissue, selectively denature the abnormal tissue, and remodel the collagen in the tubular structure.…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluations on Real-Time Monitoring of Temperature Sensors during Endoscopic Laser Application

Truong²,

Lim

et al. 2023

Sensors

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Temperature sensors, such as Fiber Bragg Grating (FBG) and thermocouple (TC), have been widely used for monitoring the interstitial tissue temperature during laser irradiation. The aim of the current study was to compare the performance of both FBG and TC in real-time temperature monitoring during endoscopic and circumferential laser treatment on tubular tissue structure. A 600-µm core-diameter diffusing applicator was employed to deliver 980-nm laser light (30 W for 90 s) circumferentially for quantitative evaluation. The tip of the TC was covered with a white tube (W-TC) in order to prevent direct light absorption and to minimize temperature overestimation. The temperature measurements in air demonstrated that the measurement difference in the temperature elevations was around 3.5 °C between FBG and W-TC. Ex vivo porcine liver tests confirmed that the measurement difference became lower (less than 1 °C). Ex vivo porcine esophageal tissue using a balloon-integrated catheter exhibited that both FBG and W-TC consistently showed a comparable trend of temperature measurements during laser irradiation (~2 °C). The current study demonstrated that the white tube-covered TC could be a feasible sensor to monitor interstitial tissue temperature with minimal overestimation during endoscopic laser irradiation. Further in vivo studies on gastroesophageal reflux disease will investigate the performance of the W-TC to monitor the temperature of the esophageal mucosa surface in real-time mode to warrant the safety of endoscopic laser treatment.

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“…18,19,25 Recent studies introduced a balloon-integrated diffusing applicator (BDA) to treat tubular tissues (bile duct and esophagus) by inflating the balloon for tissue dilation and simultaneously irradiating the light on the inner lumen for irreversible thermal coagulation. [26][27][28] A collective treatment with mechanical pressure and thermal coagulation may expand the tissue with stenosis and denature mucosal fibrosis. In addition, the balloon catheter can position the optical diffuser at the center of the lumen consistently.…”

Section: Introductionmentioning

confidence: 99%

“…To avoid the perforation during laser therapy that includes PDT using a diffuser on the tubular tissue, dilation was an integral part in terms of uniform irradiation of low power laser light onto the large area 18,19,25 . Recent studies introduced a balloon‐integrated diffusing applicator (BDA) to treat tubular tissues (bile duct and esophagus) by inflating the balloon for tissue dilation and simultaneously irradiating the light on the inner lumen for irreversible thermal coagulation 26–28 . A collective treatment with mechanical pressure and thermal coagulation may expand the tissue with stenosis and denature mucosal fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Impact of residual air trap in balloon on laser treatment of tubular tissue

2022

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Objectives: Tubular tissue, such as the bile duct and esophagus, often suffers from stenosis due to chronic inflammation or excessive contraction of smooth muscle. Laser treatment using a balloon catheter has been used to treat tubular tissue stenosis by mechanically expanding the tissue and irradiating laser light circumferentially on the tissue lumen. As the balloon is inflated with saline, the residual air in a delivery channel is often accumulated in the inflated balloon. Thus, the air trap may cause physical discontinuities at air-saline interface, leading to unpredictable and nonuniform photothermal interactions. The aim of the current study was to evaluate the optical-thermal effects of the air trap in the balloon on laser treatment of the tubular tissue by means of numerical simulations and experimental validations. Materials and Methods: A balloon-assisted diffusing applicator (BDA) was developed to inflate a balloon and deliver uniform and circumferential laser light. Before the balloon inflation, various numbers of deflations (0, 1, 2, 3, and 4) were applied to estimate the average amount of the air removed from the balloon. Ex vivo experiments using porcine liver duct were conducted with two deflation conditions (D0: no deflation for air trap and D3: three deflations for no air trap). The balloon was horizontally situated during laser irradiation to maintain the air trap at the same position in the balloon by minimizing gravity effect. Upon balloon inflation, 532 nm laser light was delivered through the BDA to the tissue (irradiance = 4 W/cm 2 ) at 10 W for 45 seconds to assess the optical-thermal effects of the air trap on the ductal tissue. Results: The size of the air trap was noticeably reduced with the number of deflations. The air trap volume in the balloon decreased to 0.5% of the total balloon volume after D3. Ex vivo results demonstrated that thicker coagulative necrosis (CN) for D0 near the air trap region in the tissue than bottom region that contact with saline, representing an asymmetric profile of CN in the tissue. D0 generated 17% thicker and nonuniform CN (overall CN thickness = 1.4 ± 0.7 mm), compared with D3 with no air trap (overall CN thickness = 1.2 ± 0.2 mm; p < 0.05). A threefold larger eccentricity (E) was found in D0 (49 ± 31%) than D3 (15 ± 13%; p < 0.001). Conclusion: Both numerical simulations and experiments validated the effect of the air trap in a balloon on the distribution of CN in a tubular tissue during BDAassisted laser treatment. Further in vivo studies will assess the current findings on the air trap for clinical translations of BDA-assisted laser treatment of tubular tissue stenosis.

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Feasibility study of endoscopic thermal coagulation with circumferential laser irradiation for treating esophageal tissue

Cited by 5 publications

References 20 publications

Feasibility Study on Endoscopic Balloon-Assisted Laser Treatment (EBLT) of Gastroesophageal Reflux Disease (GERD) in In Vivo Porcine Model

Feasibility Study on Endoscopic Balloon-Assisted Laser Treatment (EBLT) of Gastroesophageal Reflux Disease (GERD) in In Vivo Porcine Model

Comparative Evaluations on Real-Time Monitoring of Temperature Sensors during Endoscopic Laser Application

Impact of residual air trap in balloon on laser treatment of tubular tissue

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