PURPOSE: To evaluate the chronological effects of irreversible electroporation (IRE) on large hilar bile ducts in an in vivo porcine model correlated with computed tomography (CT) cholangiography and histopathology. MATERIALS AND METHODS: Twelve IRE zones were made along hilar bile ducts intraoperatively under ultrasound (US)-guidance in 11 pigs. Paired electrodes were placed either on opposing sides of the bile duct (straddle [STR]) or both on one side of the bile duct (one-sided [OSD]). The shortest electrode-to-duct distance was classified as periductal (≤ 2 mm) or nonperiductal (>2 mm). CT cholangiography and laboratory tests were performed before IRE and again at 2 days, 4 weeks, and 8 weeks after IRE. Degree of bile duct injury were graded as follows: grade 0 = no narrowing; grade 1 = ≤ 50 % duct narrowing; grade 2 = >50 % narrowing without proximal duct dilatation; grade 3 = grade 2 with proximal duct dilatation; and grade 4 = grade 3 with enzyme elevation. Pigs were selected for killing and histopathology at 2 days, 4, and 8 weeks. RESULTS: Nonperiductal electrode placement produced no long-term strictures in 5 of 5 ducts. Periductal electrode placement produced mild narrowing in 6 of 7 ducts: 5 grade 1 and 1 grade 2. None showed increased enzymes. There was no significant difference between STR versus OSD electrode placement. Histopathology showed minor but relatively greater ductal mural changes in narrowed ducts. CONCLUSION: In the larger hilar ducts, long-term patency and mural integrity appear resistant to IRE damage with the energy deposition used, especially if the electrode is not immediately periductal in position.
PURPOSE: To evaluate the chronological effects of irreversible electroporation (IRE) on large hilar bile ducts in an in vivo porcine model correlated with computed tomography (CT) cholangiography and histopathology. MATERIALS AND METHODS: Twelve IRE zones were made along hilar bile ducts intraoperatively under ultrasound (US)-guidance in 11 pigs. Paired electrodes were placed either on opposing sides of the bile duct (straddle [STR]) or both on one side of the bile duct (one-sided [OSD]). The shortest electrode-to-duct distance was classified as periductal (≤ 2 mm) or nonperiductal (>2 mm). CT cholangiography and laboratory tests were performed before IRE and again at 2 days, 4 weeks, and 8 weeks after IRE. Degree of bile duct injury were graded as follows: grade 0 = no narrowing; grade 1 = ≤ 50 % duct narrowing; grade 2 = >50 % narrowing without proximal duct dilatation; grade 3 = grade 2 with proximal duct dilatation; and grade 4 = grade 3 with enzyme elevation. Pigs were selected for killing and histopathology at 2 days, 4, and 8 weeks. RESULTS: Nonperiductal electrode placement produced no long-term strictures in 5 of 5 ducts. Periductal electrode placement produced mild narrowing in 6 of 7 ducts: 5 grade 1 and 1 grade 2. None showed increased enzymes. There was no significant difference between STR versus OSD electrode placement. Histopathology showed minor but relatively greater ductal mural changes in narrowed ducts. CONCLUSION: In the larger hilar ducts, long-term patency and mural integrity appear resistant to IRE damage with the energy deposition used, especially if the electrode is not immediately periductal in position.
Authors: Eisuke Ueshima; Mark Schattner; Robin Mendelsohn; Hans Gerdes; Sebastien Monette; Haruyuki Takaki; Jeremy C Durack; Stephen B Solomon; Govindarajan Srimathveeravalli Journal: Gastrointest Endosc Date: 2017-05-10 Impact factor: 9.427
Authors: J J Wendler; R Ganzer; B Hadaschik; A Blana; T Henkel; K U Köhrmann; S Machtens; A Roosen; G Salomon; L Sentker; U Witzsch; H P Schlemmer; D Baumunk; J Köllermann; M Schostak; U B Liehr Journal: Urologe A Date: 2015-06 Impact factor: 0.639
Authors: Robert J S Coelen; Jantien A Vogel; Laurien G P H Vroomen; Eva Roos; Olivier R C Busch; Otto M van Delden; Foke van Delft; Michal Heger; Jeanin E van Hooft; Geert Kazemier; Heinz-Josef Klümpen; Krijn P van Lienden; Erik A J Rauws; Hester J Scheffer; Henk M Verheul; Jan de Vries; Johanna W Wilmink; Barbara M Zonderhuis; Marc G Besselink; Thomas M van Gulik; Martijn R Meijerink Journal: BMJ Open Date: 2017-09-01 Impact factor: 2.692