Abstract
Backgrounds. Limited effective palliative treatments exist for pancreatic cancer which includes surgery or chemotherapy. Radiofrequency ablation (RFA) uses high frequency alternating current to ablate diseased tissue and has been used to treat various tumors. In this study, we evaluated a prototype probe adjusted to the EUS-needle to perform EUS-RFA to permit coagulative necrosis in the pancreas. Methods. Five Yucatan pigs underwent EUS-guided radiofrequency ablation of the head of their pancreas. Using an EUS-needle, RFA was applied with 6 mm and then 10 mm of the probe exposed at specific wattage for preset durations. Results. Only one pig showed moderate levels of pancreatitis (20% proximal pancreatitis). The other animals showed much lower areas of tissue damage. In 3 of the 5 pigs, the proximal pancreas showed greater levels of tissue injury than the distal pancreas, consistent with the proximity of the tissue to the procedure site. In 1 pig, both proximal and distal pancreas showed minimal pancreatitis (1%). There was minimal evidence of fat necrosis in intra-pancreatic and/or extra-pancreatic adipose tissue. Conclusion. EUS-guided RFA of the pancreatic head with the monopolar probe through a 19-gauge needle was well tolerated in 5 Yucatan pigs and with minimal amount of pancreatitis.
Highlights
Pancreatic cancer is the fourth leading cause of cancer death in the USA [1]
In one animal, there was minimal (1%) pancreatitis in both the proximal and distal pancreas, and in one animal, slightly more injury was seen in the distal pancreas versus the proximal pancreas (4% versus 1%)
When attached to a generator, RF current is emitted from the exposed portion of the electrode and this current translates into ion agitation within the surrounding tissue, which is converted by friction into heat and induces cellular death by means of coagulation necrosis [12, 13]
Summary
The 5-year survival rate is only 3% with a median survival of less than 6 months [2]. Conventional treatment approaches, such as surgery, radiation, chemotherapy, or combinations of these, have little impact on the course of this aggressive cancer [3]. Recent studies have shown the feasibility of monopolar RF ablation in patients with stage III pancreatic cancer in open, percutaneous, or laparoscopic setting [5, 6]. The objective of the study was to report safety and efficacy of EUS-guided transduodenal RF ablation of porcine pancreas using a new well-shaped monopolar probe (Habib EUS RFA, EMcision Ltd., London, UK) that fits better into the EUS needle. The improved needle design should hypothetically permit coagulative necrosis of larger areas of the pancreas, while still minimizing the risk of damage to the intestinal mucosa
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