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Feasibility of balloon-based endobiliary radiofrequency ablation under cholangioscopy guidance in a swine model.

ABSTRACT: Although endobiliary radiofrequency ablation (RFA) has demonstrated considerable potential for the treatment of biliary strictures, conventional catheter RFA has several limitations. This study aimed to evaluate the feasibility of a novel cholangioscopy (CS)-guided balloon-based RFA procedure in vivo using a swine model. CS-guided balloon-RFA was performed under endoscopic retrograde cholangiography guidance at target temperatures of 60 ℃ or 70 ℃, which were maintained for 60 s. We evaluated the technical feasibility, adverse events, and histological effects associated with the procedure. Twelve sites were ablated in seven miniature pigs. The CS-guided balloon-RFA procedure was technically successful in all cases without any hindrance. Mucosal changes could be detected during RFA, and the ablation area was identified on CS. Necropsy was performed in four pigs on the same day as the procedure: the tissue samples showed coagulative necrosis, and the entire internal circumference of the bile duct was uniformly ablated. The mean lengths of the ablation area in the samples ablated at 60 °C and 70 °C were 20.64 and 22.18 mm, respectively, while the mean depths were 3.46 and 5.07 mm, respectively. The other three pigs were reared and euthanized and autopsied 35 days after the procedure. The site to be ablated had replaced the granulation tissue and fibrotic changes. No adverse events were observed in any case. CS-guided balloon-RFA appears to be a promising option for treating biliary strictures. This preliminary study could pave the way for the evaluation of this procedure in future human clinical trials.

SUBMITTER: Inoue T

PROVIDER: S-EPMC8270987 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:A 73-year-old woman underwent radiofrequency hot balloon ablation (RHBA) for paroxysmal atrial fibrillation. After delivery into the left inferior pulmonary vein (LIPV), the guidewire perforated the venous wall. We injected contrast medium while the inflated balloon occluded the PV. Subsequently, bronchial-pulmonary venous fistula (BPVF) occurred and the severe hypoxia caused pulseless electrical activity (PEA). Cardiopulmonary resuscitation and intubation quickly recovered spontaneous circulation. She was initially treated by a multidisciplinary team in the intensive care unit and subsequently discharged without sequelae. Although relatively rare, there are some reports of wire perforation during RHBA and cryoballoon ablation. Some cases resolved after discontinuing anticoagulant therapy, while others required invasive procedures. This is the first case in which hypoxia, shock, and PEA were caused by wire perforation. As such complications can occur in all balloon ablation procedures, operators need to take care when using the guidewire and guide catheter. Anticoagulant therapy should be discontinued following PV perforation, if possible. Hemostasis with ventilator management is desirable. If hemostasis cannot be achieved, lung resection must be considered. Although wire perforation causing BPVF is rare, establishment of preventive measures and treatment protocols is needed. <Learning objective: The safety of radiofrequency hot balloon (RHB) ablation for paroxysmal atrial fibrillation has been established. This case report presents the rare complication of a soft J-tipped guidewire perforating the pulmonary vein (PV) without any resistance. Pulmonary venography was performed with the RHB blocking the PV, eventually causing pulseless electrical activity from hypoxia due to a bronchial-pulmonary venous fistula. Artificial ventilation management by positive end expiratory pressure after discontinuing anticoagulant therapy was effective for hemostasis and improvement of respiratory condition.>.

Project description:BACKGROUND:Pulsed field ablation (PFA) can be myocardium selective, potentially sparing the esophagus during left atrial ablation. In an in vivo porcine esophageal injury model, we compared the effects of newer biphasic PFA with radiofrequency ablation (RFA). METHODS:In 10 animals, under general anesthesia, the lower esophagus was deflected toward the inferior vena cava using an esophageal deviation balloon, and ablation was performed from within the inferior vena cava at areas of esophageal contact. Four discrete esophageal sites were targeted in each animal: 6 animals received 8 PFA applications/site (2 kV, multispline catheter), and 4 animals received 6 clusters of irrigated RFA applications (30 W×30 seconds, 3.5 mm catheter). All animals were survived to 25 days, sacrificed, and the esophagus submitted for pathological examination, including 10 discrete histological sections/esophagus. RESULTS:The animals weight increased by 13.7±6.2% and 6.8±6.3% (P=0.343) in the PFA and RFA cohorts, respectively. No PFA animals (0 of 6, 0%) developed abnormal in-life observations, but 1 of 4 RFA animals (25%) developed fever and dyspnea. On necropsy, no PFA animals (0 of 6, 0%) demonstrated esophageal lesions. In contrast, esophageal injury occurred in all RFA animals (4 of 4, 100%; P=0.005): a mean of 1.5 mucosal lesions/animal (length, -21.8±8.9 mm; width, -4.9±1.4 mm) were observed, including one esophago-pulmonary fistula and deep esophageal ulcers in the other animals. Histological examination demonstrated tissue necrosis surrounded by acute and chronic inflammation and fibrosis. The necrotic RFA lesions involved multiple esophageal tissue layers with evidence of arteriolar medial thickening and fibrosis of periesophageal nerves. Abscess formation and full-thickness esophageal wall disruptions were seen in areas of perforation/fistula. CONCLUSIONS:In this novel porcine model of esophageal injury, biphasic PFA induced no chronic histopathologic esophageal changes, while RFA demonstrated a spectrum of esophageal lesions including fistula and deep esophageal ulcers and abscesses.

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Feasibility of balloon-based endobiliary radiofrequency ablation under cholangioscopy guidance in a swine model.

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