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Ex vivo human bile duct radiofrequency ablation with a bipolar catheter

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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.

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Authors and Affiliations

  1. Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, 3-H GI Associates, Zero Emerson Place, Blossom St., Boston, MA, 02114, USA

    Mustafa Atar, Abdurrahman Kadayifci, Ebubekir Daglilar & William R. Brugge

  2. Unit of Gastroenterology, Reyap Istanbul Hospital, Istanbul, Turkey

    Abdurrahman Kadayifci

  3. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Catherine Hagen

  4. Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

    Catherine Hagen

  5. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Carlos Fernandez-del Castillo

Authors
  1. Mustafa Atar
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  2. Abdurrahman Kadayifci
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  3. Ebubekir Daglilar
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  4. Catherine Hagen
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  5. Carlos Fernandez-del Castillo
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  6. William R. Brugge
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Corresponding author

Correspondence to Abdurrahman Kadayifci.

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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.

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Atar, M., Kadayifci, A., Daglilar, E. et al. Ex vivo human bile duct radiofrequency ablation with a bipolar catheter. Surg Endosc 32, 2808–2813 (2018). https://doi.org/10.1007/s00464-017-5984-0

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  • DOI: https://doi.org/10.1007/s00464-017-5984-0

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