Irreversible electroporation (IRE) is relatively novel method for percutaneous treatment of liver lesions. The major technological advancement is low heat production and independence of ablation shape and volume due to thermal lost. Thus IRE could be safely delivered to proximity of major hepatic vessels and bile ducts. Despite of these benefits there is few information about IRE used endoluminally in biliary tract (1).
Biliary metal stents are recommended only in malignant biliary obstruction with survival expectancy over 3 moths (2), frequently the patients survival exceed...
Methods and materials
The experiment was performed in two phases – ex-vivo and in-vivo.
In all scenarios were used biliary metal stents EGIS 10x80mm and experimental tubular IRE catheters with 3 electrodes, which were inserted in the metal stent. The IRE catheter was connected to an IRE generator, with two electrodes set as active and one as indifferent.
Ex vivo part
Nonviable porcine liver were used in ex-vivo part. Metal stents were inserted into deep grooves, which were cut by scalpel in blocks of tissue. The bare parts...
Ex vivo part
Totally 72 IRE procedures in all scenarios were performed (10 in scenario A, 10 in scenario B, 31 in scenario C, 21 in scenario D). All scenarios with 300 a 650 V were successfully performed in the whole extent. Short circuit occurred at 1000 V in all cases in scenario B (both electrodes directly in contact with the metal stent, no inserted liver tissue) and in two of ten cases in scenario C (one active electrode in contact with the stent and...
Endoluminal irreversible electroporation using tubular catheter seems safe and feasible method and has potential for non-thermal metal stent ingrowth treatment.
The relationship between the stent and the IRE electrode can be estimated based on impedance values.
Personal information and conflict of interest
T. Rohan; Brno/CZ - nothing to disclose T. Andrasina; Brno/CZ - nothing to disclose T. Juza; Brno/CZ - nothing to disclose P. Matkulcik; Brno/CZ - nothing to disclose D. Červinka; Brno/CZ - nothing to disclose I. Svobodova; Brno/CZ - nothing to disclose V. Valek; Brno/CZ - nothing to disclose
1. Ueshima E, Schattner M, Mendelsohn R, et al. Transmural ablation of the normal porcine common bile duct with catheter-directed irreversible electroporation is feasible and does not affect duct patency. Gastrointest Endosc. 2018;87(1):300.e1-300.e6.
2. Rerknimitr R, Angsuwatcharakon P, Ratanachu‐ek T, et al. Asia–Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol. 28(4):593–607.
3. Mizandari M, Pai M, Xi F, et al. Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results. Cardiovasc Intervent Radiol....