Hydrothermal Ablation Research Articles

Recellularization via electroporation therapy of the duodenum combined with glucagon-like peptide-1 receptor agonist to replace insulin therapy in patients with type 2 diabetes: 12-month results of a first-in-human study

Studies have shown that hydrothermal duodenal mucosal ablation results in improved glycemic control. Recellularization via electroporation therapy (ReCET) is a novel endoscopic procedure that uses electroporation to induce cellular apoptosis and subsequent reepithelization. In this study, we aimed to eliminate exogenous insulin treatment in type 2 diabetes (T2D) patients through a single ReCET procedure combined with a glucagon-like peptide-1 receptor agonist. Feasibility, safety, and (dose) efficacy of ReCET were assessed. This first-in-human study included patients with T2D on basal insulin (age, 28-75 years; body mass index, 24-40 kg/m2; glycosylated hemoglobin,≤64mmol/mol; C-peptide,≥0.2 nmol/L). The electroporation dose was optimized during the study, starting with single 600 V and ending with double 750 V treatments. All patients underwent ReCET, after which insulin was discontinued and semaglutide (glucagon-like peptide-1 receptor agonist) was initiated. The primary endpoints were feasibility (procedure time [from catheter in to catheter out], technical success rate), safety, and efficacy (patients off insulin at 6 months; HbA1c,≤58mmol/mol). Fourteen patients underwent endoscopic ReCET. The median procedure time was 58 (interquartile range, 49-73) minutes. ReCET demonstrated a technical success rate of 100%. No device-related severe adverse events or severe hypoglycemic events were observed. At the 12-month follow-up, 12 (86%) patients remained off exogenous insulin therapy, with significant improvements in glycemic control and metabolic parameters. The 2 patients in whom insulin therapy was reintroduced both received ReCET at the lowest voltage (single 600 V). These results suggest that ReCET is feasible and safe. In combination with semaglutide, ReCET may be a promising therapeutic option to replace insulin therapy in selected T2D patients while improving glycemic control and metabolic health.

Hydrothermal ablation in recurrent or chronic olecranon bursitis: a prospective study

Olecranon bursitis can be difficult to treat, resulting in persistent or recurrent symptoms. Bursectomy is a frequently applied treatment option for refractory cases but has high complication rates. This is the first invivo study to investigate the safety and efficacy of hydrothermal ablation, a new treatment modality for recurrent or chronic olecranon bursitis that aims to cause thermal obliteration of the bursal lining by irrigation with heated saline. First, a pilot animal trial was set up to determine a safe irrigation temperature window. Second, in a human trial the bursae of patients with chronic, recurrent, or refractory olecranon bursitis were irrigated with a 3-mL/s flow of physiological saline for a duration of 180 seconds at temperatures between 50°C and 52°C. Patients were followed up for 6 months, allowing for assessment of the surgical site to screen for adverse events, volumetric ultrasonographic assessment of the bursae, and collection of the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Patient Global Impression Score, and Clinical Global Impression Score, as well as data on return to activities or work. Twenty-four elbows were prospectively included and underwent a full cycle of hydrothermal ablation. The mean age was 58.4 years (range 40.5-81.5), including 20 male and 4 female patients. None had clinical signs of septic bursitis. Bursal fluid cultures were positive in only 1 case. The average preoperative bursal volume was 11.18 mL (range 4.13-30.75). Eighteen of 24 elbows (75%) were successfully treated, showing a complete remission of symptoms or decided improvement within 6 weeks and without any signs of recurrence during the entire follow-up period of 6 months. The average reduction of ultrasonography-measured bursal volume was 91.9% in the group of patients who responded to treatment. In patients without recurrence, the mean QuickDASH scores before and after treatment were 13.6 (range 0-50) and 3.1 (range 0-27.5), respectively, showing a statistically significant improvement. All patients were able to fully return to work within 6 weeks after the index procedure. No serious adverse events were encountered. Moderate local adverse events were found in 2 patients. Increasing temperatures of irrigation did not result in a higher treatment efficacy. Hydrothermal ablation at temperatures between 50°C and 52°C is a safe treatment option for recurrent or chronic olecranon bursitis with fewer complications than open bursectomy and a comparable efficacy.

Endoscopic duodenal mucosa ablation techniques for diabetes and nonalcoholic fatty liver disease: A systematic review

Type 2 diabetes mellitus (T2DM) is increasing at an alarming rate, and only 50% of patients with T2DM achieve or maintain adequate glycemic control with pharmacological therapies. Metabolic surgery demonstrated superior efficacy compared to medical therapy but is unfeasible for most patients with T2DM. Duodenal mucosal resurfacing (DMR) by hydrothermal mucosal ablation, recellularization via electroporation therapy (ReCET), and photodynamic therapy are novel endoscopic procedures that use thermal, electrical, and photochemical energy, respectively, to ablate and reset dysfunctional duodenal mucosa. We assessed the data on the effects of these techniques on glycemic control and nonalcoholic fatty liver disease (NAFLD). We systematically searched independently and in duplicate English and non-English language publications through January 31st, 2024. Outcomes assessed were an improvement in different metabolic health parameters and the safety of duodenal mucosal ablation (DMA) procedures. Outcomes were presented descriptively. We selected 12 reports reporting results from 3 randomized and 6 uncontrolled trials (seven evaluating DMR, two evaluating ReCET, all with a low risk of bias) for a total of 317 patients enrolled. DMA reduced HbA1c, fasting plasma glucose, and liver fat. When combined with newer antidiabetic drugs, it allowed insulin discontinuation in up to 86% patients. No major safety signal emerged. All DMA techniques improve glucose homeostasis; DMR and ReCET appear to be safe in patients with T2DM. If confirmed by future randomized trials and by trials with histological endpoints in NAFLD, then DMA appears to be a promising alternative or complement option to medications for T2DM and NAFLD treatment. This study received no funding.

Fabrication of MoO3/rGO/Au composite for increased photocatalytic degradation of methylene blue

Water line purification and wastewater treatment have become challenging in the fast-growing industry, infrastructure, textile, manufacturing world, etc. with this challenge, photocatalysis has gained substantial attention as an environmentally friendly process on which researchers are working aggressively and, in this progress, two-dimensional (2D) are in focus because of their good photocatalytic ability. Therefore, in this study, we present the synthesis of one such ternary composite material comprising molybdenum trioxide nanorods (MoO3NR), reduced graphene oxide (rGO) and gold nanoparticles (AuNR), with a specific focus on its enhanced photocatalytic performance. The ternary composite is prepared via a combination of in situ hydrothermal and laser ablation methods allowing for precise control over the growth and integration of the constituent materials. The structural and morphological properties of the MoO3 nanorods, rGO and Au ternary material were systematically characterized using various techniques, including UV-vis spectroscopy, X-ray diffraction (XRD), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). The obtained results suggest the successful formation of a composite, revealing the presence of uniformly dispersed MoO3 nanorods on the rGO sheets and evenly distributed Au nanoparticles throughout the structure. Photocatalysis evaluations conducted to assess the material performance under visible light irradiation exhibited significantly enhanced methylene blue degradation efficiency of 85.91% in 90[Formula: see text]min in comparison with individual MoO3 nanorods and rGO counterparts. The improved efficiency can be attributed to the combined effects arising from the integration of MoO3 nanorods, rGO and Au nanoparticles, which facilitate efficient light absorption, charge separation and catalytic reactions, which in turn reduces electron–hole recombination and improve photocatalytic performance. Also, the tunable morphology and collective effects of MoO3 nanorods, rGO and Au offer new avenues for designing highly efficient and stable photocatalytic materials.

Photocatalytic studies of tin oxide nanostructures produced by different methods

This paper reports the photocatalytic behavior of tin oxide (SnO2) nanostructures prepared via three different aqueous solution-processed techniques: Precipitation, hydrothermal, and laser ablation. The prepared SnO2 nanostructures were characterized by X-ray diffraction (XRD) and field electron scanning electron microscopy (SEM). The photocatalytic activity was evaluated by the oxidative degradation of rhodamine blue (RhB) under visible light. The SnO2 nanostructure prepared by the laser ablation method exhibit significantly improved photocatalytic activity toward RhB due to the size and morphology of the prepared nanostructure.

Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis.

Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis.

Treatment Failure Rates of Second-Generation Endometrial Ablation Devices in Premenopausal Women with BMI≥35 Kg/m2

<h3>Study Objective</h3> To investigate the treatment failure rates of second-generation endometrial ablation (EA) devices in obese women with BMI≥35 kg/m² in a multi-site single health care system. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Academic community health care system. <h3>Patients or Participants</h3> Premenopausal women aged 18-51 years old who underwent second-generation endometrial ablation for benign indications. <h3>Interventions</h3> Women underwent Radiofrequency Ablation (RFA), Hydrothermal Ablation, Uterine Balloon Ablation, or Combined Argon/RFA Ablation between January 2010 to December 2020. <h3>Measurements and Main Results</h3> 1328 women were identified who underwent second-generation EA of which 1198 patients met criteria. Failure was defined as re-intervention via repeat EA or hysterectomy for persistent uterine bleeding. The overall EA failure rate was 13.9%, with a total of 167 women who required a re-intervention. The proportion of women with BMI<35 kg/m² vs BMI≥35 kg/m² who had a re-intervention was 12.3% vs 17.6% (p=0.019), with an odds ratio of 1.520 (95% CI: 1.083-2.132). Common preoperative diagnoses for re-intervention were abnormal uterine bleeding (73.7%), pelvic pain (50.3%), and fibroid (29.9%). Significant findings on pathology reports after re-intervention showed adenomyosis (44.9%) and fibroids (40.7%). The median time lapse between initial EA and re-intervention was 477 days. <h3>Conclusion</h3> Obesity (BMI≥35 kg/m²) is a risk factor for failure of an endometrial ablation procedure. These findings may be helpful in determining appropriate candidates for this treatment option, as well as improving counseling on possible failure and subsequent risk of re-intervention after an endometrial ablation.

Charge separation dynamics in In2Se3/ZnO/Au ternary system for enhanced photocatalytic degradation of methylene blue under visible light

In this study, carrier dynamics and photocatalytic performance of In2Se3/ZnO/Au-nanoparticle ternary composite is reported. The novel photocatalyst In2Se3/ZnO/Au-nanoparticle was fabricated using the hydrothermal and laser ablation techniques. The structural and physical characteristics have been studied by scanning electron microscopy (SEM), tunneling electron microscopy (TEM), ultraviolet-visible (UV–vis) spectrophotometry, and Raman spectroscopy. The photocatalytic activity of the nanocomposites was estimated through the photocatalytic degradation utilizing organic dye of methylene blue in an aqueous solution. The result suggests that the ternary composite showed better photocatalytic performance compared with the pristine and binary composites. The efficient photocatalytic activity is attributed to the active participation of conduction band of ZnO, large surface area, and excitation of both In2Se3 and Au nanoparticle, and increased electron population in In2Se3. The photocatalytic activities were correlated and explained with the carrier dynamics measured from ultrafast transient absorption spectroscopy. It is found that In2Se3/ZnO/Au system shows the higher adsorption among all systems which indicates that electron transfer to methylene blue is got faster for reduction. The correlation of photocatalytic activities with charge separation dynamic of In2Se3/ZnO/Au-nanoparticle ternary composite provides new direction and understanding to fabricate ternary composite based efficient and high-performance photocatalyst.

Duodenal mucosal resurfacing: Multicenter experience implementing a minimally invasive endoscopic procedure for treatment of type 2 diabetes mellitus.

Background and study aims Duodenal mucosal resurfacing (DMR) is an endoscopic procedure which improves insulin resistant metabolic disease, including type 2 diabetes mellitus (T2DM). The aim of this report was to evaluate the feasibility and procedural aspects of DMR and to provide more specific DMR procedural guidance for endoscopists. Patients and methods In this international multicenter, prospective, open-label study, patients on oral anti-diabetic agents for treating T2DM underwent single DMR. DMR entails circumferential submucosal lifting followed by circumferential mucosal hydrothermal ablation using an over-the-guidewire balloon catheter for lifting and ablation. For the first 28 patients a dual catheter system was used. During the study, a new integrated catheter was developed which was used for the latter 18 patients. During DMR, procedure success (complete DMR: duodenal ablation length ≥ 9 cm) and procedure duration were captured. Results Forty-six patients underwent DMR. Using the dual catheter system, a complete DMR was performed in 22 of 28 patients (79 %). In the next eighteen patients who underwent DMR with the integrated catheter, a complete DMR was performed in 15 of 18 patients (83 %). The integrated catheter facilitated the DMR procedure and resulted in a reduction in procedure time. A detailed table and video are provided for future endoscopists. Conclusions In our multicenter study, DMR was found to be feasible in the hands of experienced endoscopists. The integrated DMR catheter was a welcome modification during the study, allowing for easier ablation administration. Further optimization of the technique would be valuable prior to widespread dissemination.

MORPHOLOGIES OF SILVER NANOPARTICLES (Ag NPs) SYNTHESIZED BY HYDROTHERMAL AND LASER ABLATION TECHNIQUES

Silver nanoparticles (Ag NPs) are prepared using two different techniques namely hydrothermal and laser ablation methods. The purpose of this study is to find a more suitable method to prepare Ag NPs through comparison that can give stable and size-controlled silver nanoparticles. Techniques used for observations are X-ray diffraction (XRD), transmission electron microscopy (TEM), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Comparison of results exhibited that hydrothermal process is a more suitable method to prepare silver nanoparticles with smaller uniform size and better yield as compared to laser ablation method. Also, at low temperature, NPs obtained using hydrothermal process provide better control on morphology, high purity and narrow size distribution.

Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study

BackgroundThe duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes. Duodenal mucosal...

Su1350 HISTOLOGICAL EFFECT OF THE DUODENAL MUCOSAL RESURFACING PROCEDURE: A NOVEL ANIMAL STUDY

Diabetes has reached pandemic magnitude globally. Over the last 20 years, there has been increasing evidence that bariatric surgery can elicit potent effects to improve the metabolic state in obese subjects with T2D. However, bariatric surgery is associated with a background rate of severe adverse events that renders this intervention unappealing for many patients. Approximately, 4% severe adverse events and up to 3% mortality rate have been reported. Therefore, novel minimally invasive procedures are under development that can elicit some of the benefits of bariatric surgery but with a more favorable safety and tolerability profile. Duodenal mucosal resurfacing is one that involves an endoscopic catheter-based hydrothermal ablation of the superficial duodenal mucosa. In a porcine model, we aimed to describe local duodenal tissue changes after acute hydrothermal mucosal ablation applying the the same catheter system being used in current clinical studies (Revita system) with the understanding that the pig model does have manysimialrities with human anatomy albeit a much thinner wall thickness.

Histologic assessment of the intestinal wall following duodenal mucosal resurfacing (DMR): a new procedure for the treatment of insulin-resistant metabolic disease.

Abstract Background and study aims Minimally invasive procedures that replicate aspects of bariatric surgery with more favorable safety and tolerability offer an attractive alternative in management of metabolic disease. Duodenal mucosal resurfacing (DMR), an endoscopic procedure using hydrothermal ablation, is designed to remove surface epithelium to allow subsequent epithelial regeneration and a reset to a more insulin-sensitive state. Materials and methods DMR was performed on a healthy pig under general anethesia, approximating the procedure designed for use in humans. Immediately post-DMR, analysis of the histological landscape was conducted in distinct duodenal areas that received ablation treatment. Results DMR submucosal lift and hydrothermal ablation elicited disruption of villous tips and partial disruption of the crypt base with no damage to deeper tissue. Excessive ablation (purposeful double ablation exposure) did incur damage to the underlying muscle layer. Conclusion Our results confirmed that DMR elicits superficial ablation of duodenal villi and crypts. Defining the cellular consequences of ablation and regeneration of the epithelium will aid our understanding of how and why DMR affects metabolic homeostasis.

Duodenal mucosal resurfacing: proof-of-concept, procedural development, and initial implementation in the clinical setting

We aimed to develop duodenal mucosal resurfacing (DMR), a minimally invasive upper endoscopic hydrothermal ablation procedure, to treat insulin-resistant metabolic diseases. We completed a sham-controlled, rodent proof-of-concept study and longitudinal safety study in pigs to demonstrate feasibility to test DMR in humans. Subsequently, the DMR procedure was implemented in an open-label first-in-human (FIH) study of safety and efficacy in patients with type 2 diabetes (T2D). In rats, duodenal abrasion reduced hyperglycemia by 59 mg/dL on average, compared with no change from baseline in the sham treatment arm (P< .05). In pigs, the balloon catheter successfully and safely delivered hydrothermal ablation to the duodenal mucosa and superficial submucosa. Complete mucosal healing was demonstrated by week 6. In the FIH study, hydrothermal ablation was successfully administered with no evidence of perforation, pancreatitis, or hemorrhage. Duodenal biopsy specimens obtained 3 months postprocedure demonstrated full mucosal regrowth. No inflammation was observed, and there was minimal-to-mild collagen banding deposition observed in a proportion of ablation site biopsy specimens with no evidence of fibrotic scarring. Glycemic and hepatic measures improved through 6 months of follow-up. DMR shows potential as an endoscopic intervention that improves glycemic and hepatic parameters in patients with T2D. Further mechanistic and clinical studies are underway to further explore DMR as a treatment for metabolic disease.

658 - Operative Hysteroscopy and Hydrothermal Ablation with Vaginoscopy: Tips to a Successful Hysteroscopy Complicated by Difficult Entry

Objective: To demonstrate the use of operative vaginoscopy to aid in success of operative hysteroscopy with difficult uterine entry due to altered anatomy and to demonstrate a successful hydrothermal endometrial ablation.

Duodenal Mucosal Resurfacing Elicits Improvement in Glycemic and Hepatic Parameters in Type 2 Diabetes—One-Year Multicenter Study Results

Aims: Duodenal Mucosal Resurfacing (DMR) is a novel endoscopic procedure which has been shown to improve glycemic control at 6 months in type 2 diabetes (T2D). It is thought to exert insulin-sensitizing effects. DMR entails catheter based circumferential mucosal lifting followed by hydrothermal ablation. This study aimed to extend DMR experience, determining efficacy over 12 months in T2D patients on stable oral glucose lowering treatment. Methods: Single arm, multicenter study. 46 T2D patients on oral glucose lowering medication received a DMR procedure. Impact on glycemic control (HbA1c and fasting plasma glucose), insulin resistance (HOMA-IR) and liver enzymes (AST and ALT) was determined at baseline and 1, 3, 6, 9, 12 mo post DMR. Glucose lowering medication was kept stable 6 mo post DMR and adjusted according to local guidelines thereafter. Results: See figure 1. At 12 mo: δHbA1c -1.0±0.2% (p ≤ 0.001), δFPG -41±8 mg/dL (p ≤ 0.001), δHOMA-IR -3.6±0.9 (p = 0.005), δ weight -2.7±0.6kg (p = 0.003), δALT -10±2 (p = 0.005) and δAST -6±2 (p=0.002). DMR was well tolerated with no related serious adverse events or unexpected adverse device events reported. Conclusions: Single DMR treatment elicited significant and clinically relevant reductions in glycemic and hepatic parameters that were sustained at 12 months, suggesting considerable potential of DMR for the treatment of T2D. Disclosure A.C.G. van Baar: None. M. Nieuwdorp: None. F. Holleman: Other Relationship; Self; Sanofi-Aventis, Bioton, AstraZeneca. J. Deviere: None. L. Crenier: None. R. Haidry: None. R.L. Batterham: Research Support; Self; Fractyl Laboratories, Inc.. Board Member; Self; Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc.. Advisory Panel; Self; National Institute for Health and Clinical Excellence, Nestlé. Speaker's Bureau; Self; Orexigen Therapeutics, Inc., Medtronic. D. Hopkins: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis, Roche Pharma. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., AstraZeneca, Eli Lilly and Company, Napp Pharmaceuticals, Ltd., Sunovion Pharmaceuticals Inc.. Other Relationship; Self; Diabetes UK. Speaker's Bureau; Self; Fractyl Laboratories, Inc.. L. Rodriguez Grunert: None. M. Galvao Neto: Consultant; Self; Fractyl Laboratories, Inc., GI Dynamics Inc., GI Windows, Inc., Ethicon US, LLC., Apollo EndoSurgery. P. Vignolo: None. G. Costamagna: None. J.J. Bergman: Research Support; Self; Fractyl Laboratories, Inc..

456 Iatrogenic Burns to the Skin and Lower Genital Tract Following Hydrothermal Endometrial Ablation: A Case Report and Review of the Literature

456 Iatrogenic Burns to the Skin and Lower Genital Tract Following Hydrothermal Endometrial Ablation: A Case Report and Review of the Literature

Pain is an Independent Risk Factor for Failed Global Endometrial Ablation

Study ObjectiveTo determine whether pain, as part of an indication for global endometrial ablation, is an independent risk factor for failure. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingAcademic-affiliated community hospital. PatientsWomen undergoing global endometrial ablation with radiofrequency ablation (RFA), hydrothermablation (HTA), or uterine balloon ablation (UBA) between January 2003 and December 2015. InterventionsProcedure failure was defined as subsequent hysterectomy after the index ablation. Measurements and Main ResultsA total of 5818 women who underwent an endometrial ablation were identified, including 3706 with RFA (63.7%), 1786 with HTA (30.7%), and 326 with UBA (5.6%). Of the 5818 ablations, 437 (7.5%) involved pain (i.e., pelvic pain, dysmenorrhea, dyspareunia, lower abdominal pain, endometriosis, or adenomyosis) before ablation, along with abnormal uterine bleeding. Pain as part of the preoperative diagnoses before endometrial ablation was a significant risk factor for subsequent hysterectomy compared with all other diagnoses (19.2% vs 13.5%; p = .001). Consistent with previous studies, women who underwent ablation at an older age were less likely to fail, which held true even when one of the indications for ablation was related to pain (odds ratio, 0.96/year; 95% confidence interval, 0.95–0.97). When the pathology reports of women who underwent a hysterectomy were examined, women in the pain group had lower rates of adenomyosis than women without pain (38.1% vs 50.1%; p = .04). However, there was a trend toward a higher rate of endometriosis on pathology reports (14.3% vs 8.7%; p = .09) and even higher rates of visualized endometriosis identified by operative reports in women who had pain before their ablation (42.9% vs 15.8%; p < .001). Patients who had pain before their ablation were less likely to have myomas/polyps (p = .01). ConclusionPelvic pain before global endometrial ablation is an independent risk factor for failure.

Enhanced photocatalytic activity of Au-doped Au@ZnO core-shell flower-like nanocomposites

We introduce a simple and low-cost three-step hydrothermal and pulsed laser ablation technique for the fabrication of flower-like pure ZnO nanostructures, Au@ZnO core-shell nanocomposites, and Au@ZnO/Au core-shell nanocomposites doped with various concentrations (5, 10, and 15 wt%) of Au nanoparticles without using surfactants or catalysts to enhance the catalytic performance of ZnO under UV–visible irradiation. The decoration of Au nanoparticles on the surface of ZnO promoted the absorption of visible light due to the surface plasmon resonance of Au. Further, we evaluated the photocatalytic performance of the nanocomposites in the degradation of methylene blue (MB). Our findings revealed that the Au@ZnO/Au core-shell nanocomposites with 5 wt% of doped Au NPs demonstrated the highest photocatalytic activity. In addition, radical-scavenging experiments were conducted to determine the main reactive species formed in the reaction mixture, and accordingly, a plausible photocatalytic reaction mechanism for the enhanced photodegradation of MB is presented.

Incidence and predictors of failed second-generation endometrial ablation

BackgroundThe need for any treatment following an endometrial ablation is frequently cited as “failed therapy,” with the two most common secondary interventions being repeat ablation and hysterectomy. Since second-generation devices have become standard of care, no large cohort study has assessed treatment outcomes with regard to only these newer devices. We sought to determine the incidence and predictors of failed second-generation endometrial ablation, defined as the need for surgical re-intervention.We performed a retrospective cohort study at a single academic-affiliated community hospital. Subjects included women undergoing second-generation endometrial ablation for benign indications between October 2003 and March 2016. Second-generation devices utilized during the study period included the radiofrequency ablation device (RFA), hydrothermal ablation device (HTA), and the uterine balloon ablation system (UBA).ResultsFive thousand nine hundred thirty-six women underwent endometrial ablation at a single institution (3757 RFA (63.3%), 1848 HTA (31.1%), and 331 UBA (5.6%)). The primary outcome assessed was surgical re-intervention, defined as hysterectomy or repeat endometrial ablation. Of the total 927 (15.6%) women who required re-intervention, 822 (13.9%) underwent hysterectomy and 105 (1.8%) underwent repeat endometrial ablation. Women who underwent re-intervention were younger (41.6 versus 42.9 years, p < .001), were more often African-American (21.8% versus 16.2%, p < .001), and were more likely to have had a primary radiofrequency ablation procedure (hazard ratio 1.37; 95%CI 1.01 to 1.86). Older age was associated with decreased risk for treatment failure with women older than 45 years of age having the lowest risk for failure (p < .001). Age between 35 and 40 years conferred the highest risk of treatment failure (HR 1.59, 95% CI 1.32–1.92). Indications for re-intervention following ablation included menorrhagia (81.8%), abnormal uterine bleeding (27.8%), polyps/fibroids (18.7%), and pain (9.5%).ConclusionSurgical re-intervention was required in 15.6% of women who underwent second-generation endometrial ablation. Age, ethnicity, and radiofrequency ablation were significant risk factors for failed endometrial ablation, and menorrhagia was the leading indication for re-intervention.