Surgical Endoscopy

, Volume 32, Issue 6, pp 2808–2813 | Cite as

Ex vivo human bile duct radiofrequency ablation with a bipolar catheter

  • Mustafa Atar
  • Abdurrahman Kadayifci
  • Ebubekir Daglilar
  • Catherine Hagen
  • Carlos Fernandez-del Castillo
  • William R. Brugge
Article

Abstract

Background

Management of the primary and secondary tumors of the bile ducts still remains as a major clinical challenge. Radiofrequency (RF) ablation (RFA) of these tumors is feasible but the effect of RF energy on the human common bile duct (CBD) and surrounding tissues has not been investigated. This pilot study aimed to determine the relationship between RF energy and the depth of ablation in the normal human CBD.

Methods

The study was performed on fresh ex vivo human biliary–pancreatic tissue which had been resected for a pancreatic cyst or mass. The study was conducted within 15 min after resection. A bipolar Habib RFA catheter was placed into the middle of the intact CBD, and three different (5, 7, 10 W) power settings were applied over a 90-s period by an RF generator. Gross and histological examinations were performed. The depth of coagulation necrosis in CBD and the effect of RFA on CBD wall and surrounding pancreas tissue were determined by microscopic examination.

Results

The study included eight tissue samples. 5 W power was applied to three sites and RFA caused only focal epithelial necrosis limited to the CBD mucosa. 7 and 10 W were applied to five sites and coagulation necrosis occurred in all cases. Microscopically, necrosis was transmural, involved accessory bile duct glands, and extended to the surrounding pancreatic tissue in four of these cases. Macroscopically, RFA resulted in circumferential white-yellowish color change extending approximately 2 cm of the CBD.

Conclusion

Bipolar RF energy application with 5 W resulted in limited ablation on CBD wall. However, 7 and 10 W generated tissue necrosis which extended through the CBD wall and into surrounding pancreas tissue. Endoscopic biliary RFA is an effective technique for local biliary tissue ablation but the use of high energy may injure surrounding tissue.

Keywords

Radiofrequency ablation Biliary tumors Common bile duct Pancreas Bipolar catheter 

Notes

Compliance with ethical standards

Disclosures

Abdurrahman Kadayifci, Mustafa Atar, Ebubekir Daglilar, Catherine Hagen, Carlos Fernandez-del Castillo, and William R. Brugge have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Ebata T, Ercolani G, Alvaro D, Ribero D, Di Tommaso L, Valle JW (2016) Current status on cholangiocarcinoma and gallbladder cancer. Liver Cancer 6:59–65CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Uenishi T, Yamamoto T, Takemura S, Kubo S (2014) Surgical treatment for intrahepatic cholangiocarcinoma. Clin J Gastroenterol 7:87–93CrossRefPubMedGoogle Scholar
  3. 3.
    Almadi MA, Barkun JS, Barkun AN (2015) Stenting in malignant biliary obstruction. Gastrointest Endosc Clin N Am 25:691–711CrossRefPubMedGoogle Scholar
  4. 4.
    Gazelle GS, Goldberg SN, Solbiati L, Livraghi T (2000) Tumor ablation with radio-frequency energy. Radiology 217:633–646CrossRefPubMedGoogle Scholar
  5. 5.
    Curley SA, Izzo F, Delrio P, Ellis LM, Granchi J, Vallone P, Fiore F, Pignata S, Daniele B, Cremona F (1999) Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 230:1–8CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Peter S, Mönkemüller K (2015) Ablative endoscopic therapies for Barrett’s-esophagus-related neoplasia. Gastroenterol Clin North Am 44:335–353CrossRefGoogle Scholar
  7. 7.
    Regier M, Chun F (2015) Thermal ablation of renal tumors: indications, techniques and results. Dtsch Arztebl Int 112:412–418PubMedPubMedCentralGoogle Scholar
  8. 8.
    Alexander ES, Dupuy DE (2013) Lung cancer ablation: technologies and techniques. Semin Intervent Radiol 30:141–150CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sharaiha RZ, Sethi A, Weaver KR, Gonda TA, Shah RJ, Fukami N (2015) Impact of radiofrequency ablation on malignant biliary strictures: results of a collaborative registry. Dig Dis Sci 60:2164–2169CrossRefPubMedGoogle Scholar
  10. 10.
    Kadayifci A, Atar M, Forcione DG, Casey BW, Kelsey PB, Brugge WR (2016) Radiofrequency ablation for the management of occluded biliary metal stents. Endoscopy 48:1096–1101CrossRefPubMedGoogle Scholar
  11. 11.
    Daglilar ES, Yoon WJ, Mino-Kenudson M, Brugge WR (2013) Controlled swine bile duct ablation with a bipolar radiofrequency catheter. Gastrointest Endosc 77:815–819CrossRefPubMedGoogle Scholar
  12. 12.
    Dolak W, Schreiber F, Schwaighofer H, Gschwantler M, Plieschnegger W, Ziachehabi A (2014) Endoscopic radiofrequency ablation for malignant biliary obstruction: a nationwide retrospective study of 84 consecutive applications. Surg Endosc 28:854–860CrossRefPubMedGoogle Scholar
  13. 13.
    Pai M, Valek V, Tomas A, Doros A, Quaretti P, Golfieri R, Mosconi C, Habib N (2014) Percutaneous intraductal radiofrequency ablation for clearance of occluded metal stent in malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 37:235–240CrossRefPubMedGoogle Scholar
  14. 14.
    Yoon WJ, Kim YT, Daglilar ES, Mino-Kenudson M, Brugge WR (2015) Evaluation of bipolar radiofrequency ablation for occluded self-expandable metal stents in the bile duct: in vivo and in vitro study. Endoscopy 47:1167–1170CrossRefPubMedGoogle Scholar
  15. 15.
    Steel AW, Postgate AJ, Khorsandi S, Nicholls J, Jiao L, Vlavianos P, Habib N, Westaby D (2011) Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc 73:149–153CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Unit of GastroenterologyReyap Istanbul HospitalIstanbulTurkey
  3. 3.Department of Pathology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  4. 4.Department of PathologyMedical College of WisconsinMilwaukeeUSA
  5. 5.Department of Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations