Novel Ablation Therapy Using Endoscopic Irreversible Electroporation in the Bile Duct: A Pilot Animal Study

Abstract

Background/Aims: Irreversible electroporation (IRE) is a relatively new ablation method. However, the application of IREablation in the treatment of biliary disease has not been attempted. A minimally invasive approach using endoscopic retrogradecholangiopancreatography (ERCP) can be a novel therapeutic modality for IRE ablation. In this study, we aimed to investigate thefeasibility of endoscopic IRE for the biliary tract using an animal model. Methods: A new catheter-type electrode was developed for endoscopic IRE ablation of the biliary tract. We performed ERCP andendoscopic IRE ablations in the normal common bile duct of Yorkshire pigs. The experimental setting of IRE was 500 V/cm (50pulses, 100-μs length). The animals were sacrificed after 24 hr, and the ablated bile duct was examined. Results: Well-demarcated focal color changes were observed on the mucosa of the common bile duct. The depth of change after IREwas confined to the mucosal and submucosal layers. Apoptotic changes in the bile duct were observed only around the IRE ablationarea. Immunohistochemistry assay showed cell death in the bile duct along the electrode. Conclusions: Endoscopic IRE ablation using ERCP was successfully performed in the common bile duct. It can be a potential optionfor the treatment of biliary tumors.