EUS-guided pancreatic radiofrequency ablation: preclinical comparison of two currently available devices in a pig model
submitted 20. Februar 2018
accepted after revision 13. April 2018
17.Januar 2019 (online)
Introduction Two devices are currently available to perform pancreatic radiofrequency ablation (P-RFA). Potential clinical indications might extend from the treatment of pancreatic cystic lesions to ablation of small pancreatic solid lesions or cytoreduction of advanced pancreatic adenocarcinomas, but more preclinical data from animal models are needed to optimize P-RFA operation.
Methods P-RFA was performed under laparotomy and under endoscopic ultrasonographic guidance on the liver and pancreatic parenchyma of four live swine using the Habib EUS RFA (EMcision Ltd, London, UK) probe and the EUS-RA needle (Taewoong Medical, Gyeonggi-do, South Korea). Animals were sacrificed 2 hours after the procedure. Influence of tuning ablation time and power on tissue ablation were studied by histopathological assessment of the maximal depth of tissue damage on representative slides for each P-RFA shot.
Results The Habib probe in the liver parenchyma resulted in tissue necrosis increasing within the range of 1.9 ± 0.5 mm (Power = 8 W, Time = 120 s) to 2.5 ± 1 mm (Power = 10 W, Time = 120 s). In the pancreatic parenchyma, tissue damage ranged from 3.1 ± 0.4 mm (Power = 8 W, Time = 120 s) to 2.3 ± 0.1 mm (12 W, 120 s) in depth. EUS RFA ablation of the liver parenchyma resulted in tissue damage ranging from 1.6 ± 0.2 mm (Power = 30 W, Time = 11 s) to 1.5 ± 0.1 mm (Power = 70 W, Time = 9 s); in the pancreas, ablation depth ranged from 3.6 ± 0.5 mm (Power = 30 W, Time = 15 s) to 3.8 ± 0.4 mm (Power = 70 W, Time = 11 s).
Conclusion Both devices allow for effective ablation of pancreatic tissue within 1.5 to 3.8 mm around the RFA electrode, with a modest influence of tuning power settings. Specific settings are recommended for each of the devices studied. Ablation of larger lesions may require more repeat P-RFA shots in different locations rather than a simple modulation of ablation parameters.
- 1 McMillan MT, Christein JD, Callery MP. et al. Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy. Surgery 2016; 159: 1013-1022
- 2 Falconi M, Eriksson B, Kaltsas G. et al. Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors. Neuroendocrinology 2016; 103: 153-171
- 3 Tanaka M, Fernández-del CastilloC, Adsay V. et al. International Association of Pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12: 183-197
- 4 Goldberg SN, Mallery S, Gazelle GS. et al. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 1999; 50: 392-401
- 5 Rustagi T, Chhoda A. Endoscopic radiofrequency ablation of the pancreas. Dig Dis Sci 2017; 62: 843-850
- 6 Signoretti M, Valente R, Repici A. et al. Endoscopy-guided ablation of pancreatic lesions: Technical possibilities and clinical outlook. World J Gastrointest Endosc 2017; 9: 41-54
- 7 Arcidiacono PG, Carrara S, Reni M. et al. Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. Gastrointest Endosc 2012; 76: 1142-1151
- 8 Song TJ, Seo DW, Lakhtakia S. et al. Initial experience of EUS guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc 2015; 83: 440-443
- 9 Pai M, Habib N, Senturk H. et al. Endoscopic ultrasound guidedradiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg 2015; 7: 52-59
- 10 Waung J, Todd JF, Keane MG. et al. Successful management of sporadic pancreatic insulinoma by endoscopic ultrasound-guided radiofrequency ablation. Endoscopy 2016; 48: E144-E145
- 11 Rossi S, Viera FT, Ghittoni G. et al. Radiofrequency ablation of pancreatic neuroendocrine tumors: a pilot study of feasibility, efficacy, and safety. Pancreas 2014; 43: 938-945
- 12 Yoon WJ, Daglilar ES, Kamionek M. et al. Evaluation of radiofrequency ablation using the 1-Fr wire electrode in the porcine pancreas, liver, gallbladder, spleen, kidney, stomach, and lymph nodes: A pilot study. Dig Endosc; 2015 DOI: 10.1111/den.12575 [Epub ahead of print]
- 13 Kim HJ, Seo DW, Hassanuddin A. et al. EUS-guided radiofrequency ablation of the porcine pancreas. Gastrointest Endosc 2012; 76: 1039-1043
- 14 Wu Y, Tang Z, Fang H. et al. High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol 2006; 94: 392-395
- 15 Silviu UB, Daniel P, Claudiu M. et al. Endoscopic ultrasound-guided radiofrequency ablation of the pancreas: An experimental study with pathological correlation. Endosc Ultrasound 2015; 4: 330-335
- 16 McGahan JP, Brock JM, Tesluk H. et al. Hepatic ablation with use of radio-frequency electrocautery in the animal model. J Vasc Interv Radiol 1992; 3: 291-297