New methods Experimental endoscopy| Volume 87, ISSUE 1, P300.e1-300.e6, January 2018

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Transmural ablation of the normal porcine common bile duct with catheter-directed irreversible electroporation is feasible and does not affect duct patency

      Background and Aims

      The aim of this study was to evaluate the feasibility and early safety of catheter-directed irreversible electroporation (IRE) of the normal common bile duct (CBD) in swine.


      IRE (2000 V, 90 pulses, 100 μs pulse) was performed in the CBD of 6 Yorkshire pigs using a catheter electrode under endoscopic guidance. Ductal patency was assessed with immediate retrograde cholangiography and contrast-enhanced CT imaging at 1 or 7 days after treatment. Animals were killed at either 1 day (n = 4, 2 ablations/animal) or 7 days (n = 2, 1 ablation/animal) after treatment. The biliary tract was extracted en bloc and the length of the ablation along the CBD mucosa was measured. The depth of ablation was quantified using cross-sections of the treated CBD wall stained with hematoxylin and eosin. Single-sample hypothesis testing was performed to verify whether the depth of ablation in the CBD was a representative outcome of IRE treatment.


      IRE of the CBD did not result in perforation or obstruction of the organ at 1 or 7 days after treatment. The length of ablation along the CBD mucosa was 17.27 ± 5.55 mm on day 1 samples, and transmural ablation of the CBD wall was a representative outcome of the treatment (7/8 samples, P < .05). Day 1 samples demonstrated loss of epithelium, transmural necrosis, with preservation of lumen integrity. Day 7 samples demonstrated re-epithelialization, with diffuse transmural fibrosis of the CBD wall. These findings were absent from sham tissue samples.


      Intraluminal catheter-directed IRE is feasible and safe for full-thickness ablation of the normal porcine CBD without affecting lumen patency up to 1 week after treatment.


      CBD (common bile duct), IRE (irreversible electroporation), RFA (radiofrequency ablation)
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          In the January issue of Gastrointestinal Endoscopy, Ueshima et al1 describe the feasibility and safety of catheter-directed irreversible electroporation (IRE) of a normal common bile duct (CBD) in an animal model. The authors report the results of their initial experience with a novel catheter (20 mm long, 7F) using a modified 240-cm balloon dilation catheter, which serves as a monopolar device to perform direct IRE at 2000 V, 90 pulses, and 100-μs pulse. On the basis of these preliminary results.
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