Prevention of benign stenosis due to endoluminal irreversibleelectroporation in bile ducts
2018
Purpose To evaluate the possibility of preventing the formation
of benign stenosis in healthy bile ducts due to endoluminal
irreversible electroporation (IRE). Material and methods
Endoluminal IRE of the common bile duct was performed on 15
porcine models using an endoluminal device inserted during
laparotomy. The IRE procedure was conducted with 90 pulses of
900-1500 V. Models categorized in group A (n=5) underwent
insertion of a biodegradable stent (30x10 mm, Ella-CS) in the
ablation site. In group B, the ablation site of the models
(n=10) remained untreated. All pigs were euthanized 22 days
post-procedure. Biochemical liver tests and MRI were employed
for follow-up on days 0, 3, and 22 after ablation. Results The
IRE treatment and stent implantation was successful in all
procedures. All animals survived over the defined study period.
All biodegradable stents remained in place of ablation until
the time of autopsy. In group A, serum bilirubin levels were
slightly elevated immediately after the procedure (average
19.08 µmol/l compared to 8.33 µmol/l in group B). On day 22,
significant elevation of serum bilirubin levels and AST levels
were observed in group B (mean 1.73 µmol/l and 18.28 µmol/l,
0.79 µkat/l and 1.74 µkat/l in groups A and B respectively,
p<0,05). MRCP sequence on day 22 showed mild or severe
dilatation of intrahepatic biliary ducts in a majority of the
models (n=9, 90%) in group B. By comparison, the image analysis
in group A revealed no intrahepatic dilatation. Conclusion The
preventive implantation of biodegradable stents following IRE
of bile ducts should be a promising technique to deal with
benign stenosis formation after treatment.
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