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Lee J, Lim JH, Seo Y, Truong VG, Jeong HJ, Lim S, Kang HW, Park JS. Comparative efficacies and safeties of cylindrical interstitial laser ablation and radiofrequency ablation on swine pancreas. Lasers Med Sci 2024; 39:40. [PMID: 38240855 DOI: 10.1007/s10103-024-03989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
Laser ablation (LA) has been evaluated for the minimally invasive thermal treatment of various cancers, but conventional unidirectional endoscopic ultrasound (EUS)-guided LA has limitations. Therefore, we developed a cylindrical laser diffuser to overcome the limitations of unidirectional EUS-guided LA. The purpose of this study was to compare the efficacies and safeties of EUS-guided LA using a novel cylindrical laser diffuser and radiofrequency ablation (RFA) in vivo in swine pancreas. EUS-guided RFA (15 W, 30 s, 450 J) and cylindrical interstitial LA (CILA) (5 W, 90 s, 450 J) were applied to normal pancreatic tissue in six anesthetized pigs (three per group). Laboratory tests were performed at baseline, immediately after ablation (day 0), and 2 days after procedures (day 2). Two days after procedures, all pigs were sacrificed, and histopathological safety and efficacy assessments were performed. Technically, EUS-guided RFA and CILA were performed successfully in all cases. No major complications, including perforation or acute pancreatitis, occurred during the experiment in either group. All animals remained in excellent condition throughout the experimental period, and laboratory tests provided no evidence of a major complication. Average necrotic volumes in the RFA and CILA groups were 424.2 mm3 and 3747.4 mm3, respectively, and average necrotic volume was significantly larger in CILA group (p < 0.001). EUS-guided RFA and CILA had acceptable safety profiles in the normal swine pancreas model. Our findings indicate EUS-guided CILA has potential for the effective local treatment of pancreatic cancer as an alternative to EUS-guided RFA.
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Affiliation(s)
- Jungnam Lee
- Digestive Disease Center, Department of Internal Medicine, Inha University College of Medicine, Inha University Hospital, 27 Inhang-Ro, Jung-Gu, Incheon, 22332, Republic of Korea
| | - Jung-Hyun Lim
- Digestive Disease Center, Department of Internal Medicine, Inha University College of Medicine, Inha University Hospital, 27 Inhang-Ro, Jung-Gu, Incheon, 22332, Republic of Korea
| | - Youjeong Seo
- Department of Pathology, Inha University College of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | | | - Hye Jung Jeong
- Digestive Disease Center, Department of Internal Medicine, Inha University College of Medicine, Inha University Hospital, 27 Inhang-Ro, Jung-Gu, Incheon, 22332, Republic of Korea
| | - Seonghee Lim
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
| | - Hyun Wook Kang
- Tecure, Inc., Busan, Republic of Korea
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
- Department of Biomedical Engineering and Marine-integrated Biomedical Technology Center, Pukyong National University, Busan, Republic of Korea
| | - Jin-Seok Park
- Department of Internal Medicine, Shihwa Medical Center, Siheung, Republic of Korea.
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Namakshenas P, Di Matteo FM, Bianchi L, Faiella E, Stigliano S, Quero G, Saccomandi P. Optimization of laser dosimetry based on patient-specific anatomical models for the ablation of pancreatic ductal adenocarcinoma tumor. Sci Rep 2023; 13:11053. [PMID: 37422486 PMCID: PMC10329695 DOI: 10.1038/s41598-023-37859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/28/2023] [Indexed: 07/10/2023] Open
Abstract
Laser-induced thermotherapy has shown promising potential for the treatment of unresectable primary pancreatic ductal adenocarcinoma tumors. Nevertheless, heterogeneous tumor environment and complex thermal interaction phenomena that are established under hyperthermic conditions can lead to under/over estimation of laser thermotherapy efficacy. Using numerical modeling, this paper presents an optimized laser setting for Nd:YAG laser delivered by a bare optical fiber (300 µm in diameter) at 1064 nm working in continuous mode within a power range of 2-10 W. For the thermal analysis, patient-specific 3D models were used, consisting of tumors in different portions of the pancreas. The optimized laser power and time for ablating the tumor completely and producing thermal toxic effects on the possible residual tumor cells beyond the tumor margins were found to be 5 W for 550 s, 7 W for 550 s, and 8 W for 550 s for the pancreatic tail, body, and head tumors, respectively. Based on the results, during the laser irradiation at the optimized doses, thermal injury was not evident either in the 15 mm lateral distances from the optical fiber or in the nearby healthy organs. The present computational-based predictions are also in line with the previous ex vivo and in vivo studies, hence, they can assist in the estimation of the therapeutic outcome of laser ablation for pancreatic neoplasms prior to clinical trials.
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Affiliation(s)
- Pouya Namakshenas
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy
| | | | - Leonardo Bianchi
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy
| | - Eliodoro Faiella
- Radiology Unit, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Serena Stigliano
- Operative Endoscopy Department, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Giuseppe Quero
- Pancreatic Surgery Unit, Gemelli Pancreatic Advanced Research Center (CRMPG), Fondazione Policlinico Universitario Agostino Gemelli IRCCS di Roma, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, 00168, Rome, Italy
| | - Paola Saccomandi
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy.
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Prete AM, Gonda TA. Endoscopic Ultrasound-Guided Local Ablative Therapies for the Treatment of Pancreatic Neuroendocrine Tumors and Cystic Lesions: A Review of the Current Literature. J Clin Med 2023; 12:jcm12093325. [PMID: 37176764 PMCID: PMC10179349 DOI: 10.3390/jcm12093325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Since its emergence as a diagnostic modality in the 1980s, endoscopic ultrasound (EUS) has provided the clinician profound access to gastrointestinal organs to aid in the direct visualization, sampling, and subsequent identification of pancreatic pathology. In recent years, advancements in EUS as an interventional technique have promoted the use of local ablative therapies as a minimally invasive alternative to the surgical management of pancreatic neuroendocrine tumors (pNETs) and pancreatic cystic neoplasms (PCNs), especially for those deemed to be poor operative candidates. EUS-guided local therapies have demonstrated promising efficacy in addressing a spectrum of pancreatic neoplasms, while also balancing local adverse effects on healthy parenchyma. This article serves as a review of the current literature detailing the mechanisms, outcomes, complications, and limitations of EUS-guided local ablative therapies such as chemical ablation and radiofrequency ablation (RFA) for the treatment of pNETs and PCNs, as well as a discussion of future applications of EUS-guided techniques to address a broader scope of pancreatic pathology.
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Affiliation(s)
- Alexander M Prete
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY 10016, USA
| | - Tamas A Gonda
- Division of Gastroenterology and Hepatology, New York University (NYU) Langone Health, New York, NY 10016, USA
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Yi Y, Li L, Li J, Shu X, Kang H, Wang C, Chang Y. Use of lasers in gastrointestinal endoscopy: a review of the literature. Lasers Med Sci 2023; 38:97. [PMID: 37022519 DOI: 10.1007/s10103-023-03755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
Lasers emit highly directional light with consistent wavelengths, and recent studies have demonstrated their successful applications in gastrointestinal endoscopic therapy. Although argon plasma coagulators (APC) became the preferred treatment option due to improved safety profile and lower costs, advancements in laser and optic fiber manufacturing have reignited interest in laser treatment. Different laser wavelengths have distinct features and applications based on their tissue absorption coefficient. Lasers with shorter wavelengths are effectively absorbed by hemoglobin, resulting in a good coagulation effect. Near-infrared lasers have ability to ablate solid tumors, while far-infrared lasers can make precise mucosal incisions without causing peripheral thermal damage. Lasers have proven to be highly applicable to endoscopy devices such as endoscopes, endoscopic ultrasound (EUS), double-balloon enteroscopes (DBE), and endoscopic retrograde cholangiopancreatography (ERCP), making them a potent tool to enhance the effectiveness of endoscopic treatments with minimal adverse events. This review aims to help readers understand the applications and effectiveness of lasers in gastrointestinal endoscopy, with the potential to promote the development and application of laser technology in the medical field.
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Affiliation(s)
- Yun Yi
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Lurao Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Jianghui Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Xiawen Shu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Hui Kang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Chun Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Ying Chang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China.
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Endoscopic Ultrasound-Guided Pancreatic Interstitial Laser Ablation Using a Cylindrical Laser Diffuser: A Long-Term Follow-Up Study. Biomedicines 2022; 10:biomedicines10112895. [PMID: 36428465 PMCID: PMC9687491 DOI: 10.3390/biomedicines10112895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS Local ablative treatment is another option for improving outcomes and has been evaluated for locally advanced pancreatic cancer. We previously suggested endoscopic ultrasound (EUS)-guided interstitial laser ablation using a cylindrical laser diffuser (CILA) might be a feasible therapeutic option based on experiments performed on pancreatic cancer cell lines and porcine model with a short follow-up (3 days). The aim of this study was to investigate the safety of EUS-CILA performed using optimal settings in porcine pancreas with a long-term follow-up (2 weeks). METHODS EUS-CILA (laser energy of 450 J; 5 W for 90 s) was applied to normal pancreatic tissue in porcine (n = 5) under EUS guidance. Animals were observed clinically for 2 weeks after EUS-CILA to evaluate complications. Computed tomography and laboratory tests were carried out to evaluate safety. Two weeks after EUS-CILA, all pigs were sacrificed, and histopathological safety and efficacy evaluations were conducted. RESULTS EUS-CILA was technically successful in all five cases. No major complications occurred during the follow-up period. Body weight of porcine did not change during the study period without any significant change in feed intake. Animals remained in excellent condition throughout the experimental period, and laboratory tests and computed tomography (CT) scans provided no evidence of a major complication. Histopathological evaluation showed complete ablation in the ablated area with clear delineation of surrounding normal pancreatic tissue. Mean ablated volume was 55.5 mm2 × 29.0 mm and mean ablated areas in the pancreatic sections of the five pigs were not significantly different (p = 0.368). CONCLUSIONS In conclusion, our experimental study suggests that EUS-CILA is safe and has the potential to be an effective local treatment modality. No major morbidity or mortality occurred during the study period. Further evaluations are warranted before clinical application.
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Papaefthymiou A, Laskaratos FM, Koffas A, Manolakis A, Gkolfakis P, Coda S, Sodergren M, Suzuki N, Toumpanakis C. State of the Art in Endoscopic Therapy for the Management of Gastroenteropancreatic Neuroendocrine Tumors. Curr Treat Options Oncol 2022; 23:1014-1034. [PMID: 35511346 DOI: 10.1007/s11864-022-00986-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT Gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) comprise a heterogeneous group of slow growing tumors arising from the neuroendocrine cells of the gastrointestinal (GI) tract. Although they are considered relatively rare, their incidence is rising and it is believed that the more frequent use of endoscopy and imaging studies have at least in part contributed to the increased diagnosis especially of localized neoplasms. The management of these neoplasms should be guided by a multidisciplinary NEN team following appropriate staging investigations. Localized neoplasms of the GI tract may be suitable for endoscopic therapy, while patients with pancreatic NENs, unsuitable for surgery, should be considered for endoscopic ultrasound (EUS)-guided ablation. In this review, we discuss the evidence regarding endoscopic resection of luminal NENs and EUS-guided therapy of pancreatic NENs. The efficacy, safety, and other longer-term outcomes of these techniques are summarized. In conclusion, this review of endoscopic therapies for localized NENs may be a useful guide for NEN clinicians and endoscopists who are considering these therapeutic options for the management of focal GEP NENs.
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Affiliation(s)
- Apostolis Papaefthymiou
- Department of Gastroenterology, General University Hospital of Larisa, Mezourlo, 41110, Larisa, Greece.,First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Macedonia, Greece
| | | | - Apostolos Koffas
- Department of Gastroenterology, General University Hospital of Larisa, Mezourlo, 41110, Larisa, Greece
| | - Anastasios Manolakis
- Department of Gastroenterology, General University Hospital of Larisa, Mezourlo, 41110, Larisa, Greece
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, 1070, Brussels, Belgium
| | - Sergio Coda
- Digestive Diseases Centre, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Mikael Sodergren
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, UK
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit (ENETS Centre of Excellence) Centre for Gastroenterology, Royal Free Hospital, London, UK
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Lim S, Truong VG, Choi J, Jeong HJ, Oh SJ, Park JS, Kang HW. Endoscopic Ultrasound-Guided Laser Ablation Using a Diffusing Applicator for Locally Advanced Pancreatic Cancer Treatment. Cancers (Basel) 2022; 14:cancers14092274. [PMID: 35565403 PMCID: PMC9102236 DOI: 10.3390/cancers14092274] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Pancreatic cancer (PC) is one of the most lethal cancers; caused by family history, obesity, diabetes, and smoking, it has a 2–9% five-year survival rate. However, patients diagnosed by endoscopic ultrasound (EUS) already have an advanced stage of PC, indicating the difficulty of surgical resection. Recently, laser ablative treatment with a diffusing applicator has been proven to be feasible for treating advanced PC. Despite the potential application for treating PC, further evaluation of acute and chronic tissue responses are essential to determine the efficacy and safety of diffusing applicator under EUS guidance. In this study, EUS-guided diffusing applicator-assisted laser ablation was evaluated to quantify the extent of the tissue response after the delivery of various energy levels. Abstract Endoscopic ultrasound (EUS)-guided cylindrical interstitial laser ablation (CILA) procedures can be used to treat unresectable pancreatic cancer (PC). The aim of this study was to investigate the acute responses of pancreatic tissue after EUS-guided CILA in vivo in porcine models. Eight pigs were tested to compare the effects of different energy levels on pancreatic tissue ablation. A 1064 nm laser system was used to deliver 5 W through a diffusing applicator. The EUS-guided CILA was performed under four different energies: 200, 400, 600, and 800 J. Three days after the experiments, histological analysis was performed. The CILA consistently generated circular coagulated necrosis (CN) in the cross-sectioned pancreatic tissue. The ablation diameter was linearly dependent on the total energy delivery. The area of the CN initially increased with total energy delivery but became saturated at 600 J. The width of the degenerative parenchyma (DP) in the native tissue beyond the CN region increased with the total energy up to 600 J, and then decreased afterward. EUS-guided CILA can be a feasible approach for treating PC. Further animal studies will investigate the chronic responses of the pancreatic tissue to examine the efficacy and safety of the proposed method for clinical translation.
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Affiliation(s)
- Seonghee Lim
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan 48513, Korea; (S.L.); (V.G.T.); (J.C.)
| | - Van Gia Truong
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan 48513, Korea; (S.L.); (V.G.T.); (J.C.)
| | - Jongman Choi
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan 48513, Korea; (S.L.); (V.G.T.); (J.C.)
| | - Hye Jung Jeong
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea;
| | - Sun-Ju Oh
- Department of Pathology, Kosin University College of Medicine, Busan 49267, Korea;
| | - Jin-Seok Park
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea;
- Correspondence: (J.-S.P.); (H.W.K.)
| | - Hyun Wook Kang
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan 48513, Korea; (S.L.); (V.G.T.); (J.C.)
- Marine—Integrated Biomedical Technology Center and Department of Biomedical Engineering, Pukyong National University, Busan 48513, Korea
- Correspondence: (J.-S.P.); (H.W.K.)
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Zhang S, Li C, Cao L, Moser MAJ, Zhang W, Qian Z, Zhang B. Modeling and ex vivo experimental validation of liver tissue carbonization with laser ablation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 217:106697. [PMID: 35180678 DOI: 10.1016/j.cmpb.2022.106697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this study was to model the process of liver tissue carbonization with laser ablation (LA). METHODS A dynamic heat source model was proposed and combined with the light distribution model as well as bioheat transfer model to predict the development of tissue carbonization with laser ablation (LA) using an ex vivo porcine liver tissue model. An ex vivo laser ablation experiment with porcine liver tissues using a custom-made 1064 nm bare fiber was then used to verify the simulation results at 3, 5, and 7 W laser administrations for 5 min. The spatiotemporal temperature distribution was monitored by measuring the temperature changes at three points close the fiber during LA. Both the experiment and simulation of the temperature, tissue carbonization zone, and ablation zone were then compared. RESULTS Four stages were recognized in the development of liver tissue carbonization during LA. The growth of the carbonization zone along the fiber axial and radial directions were different in the four stages. The carbonization zone along the fiber axial direction (L2) grew in the four stages with a sharp increase in the initial period and a minor increase in Stage 4. However, the change in the carbonization zone along the fiber radial direction (D2) increased dramatically (Stage 1) to a long-time plateau (Stages 2 and 3) followed by a slow growth in Stage 4. An acceptable agreement between the computer simulation and ex vivo experiment in the temperature changes at the three points was found at all three testing laser administrations. A similar result was also obtained for the dimensions of coagulation zone and ablation zone between the computer simulation and ex vivo experiment (carbonization zone: 2.99± 0.10 vs. 2.78 mm2, 67.39± 0.09 vs. 63.53 mm2, and 90.53± 0.11 vs. 85.15 mm2; ablation zone: 68.95± 0.28 vs. 65.29 mm2, 182.11± 0.24 vs. 213.81 mm2, and 244.80± 0.06 vs. 251.79 mm2 at 3, 5, and 7 W, respectively). CONCLUSION This study demonstrates that the proposed dynamic heat source model combined with the light distribution model as well as bioheat transfer model can predict the development of liver tissue carbonization with an acceptable accuracy. This study contributes to an improved understanding of the LA process in the treatment of liver tumors.
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Affiliation(s)
- Shiguang Zhang
- Intelligent Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, 200444, China; School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Chunlei Li
- Shanghai Advanced Research Institute, Chinese Academy of Science, Shanghai, 201024, China
| | - Lin Cao
- Department of Automatic Control and Systems Engineering, the University of Sheffield, Sheffield, UK
| | - Michael A J Moser
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Wenjun Zhang
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Zhiqin Qian
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, 200237, China.
| | - Bing Zhang
- Intelligent Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, 200444, China.
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Akhter F, Manrique-Bedoya S, Moreau C, Smith AL, Feng Y, Mayer KM, Hood RL. Assessment and Modeling of Plasmonic Photothermal Therapy Delivered via a Fiberoptic Microneedle Device Ex Vivo. Pharmaceutics 2021; 13:2133. [PMID: 34959414 PMCID: PMC8703536 DOI: 10.3390/pharmaceutics13122133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] Open
Abstract
Plasmonic photothermal therapy (PPTT) has potential as a superior treatment method for pancreatic cancer, a disease with high mortality partially attributable to the currently non-selective treatment options. PPTT utilizes gold nanoparticles infused into a targeted tissue volume and exposed to a specific light wavelength to induce selective hyperthermia. The current study focuses on developing this approach within an ex vivo porcine pancreas model via an innovative fiberoptic microneedle device (FMD) for co-delivering light and gold nanoparticles. The effects of laser wavelengths (808 vs. 1064 nm), irradiances (20-50 mW·mm-2), and gold nanorod (GNR) concentrations (0.1-3 nM) on tissue temperature profiles were evaluated to assess and control hyperthermic generation. The GNRs had a peak absorbance at ~800 nm. Results showed that, at 808 nm, photon absorption and subsequent heat generation within tissue without GNRs was 65% less than 1064 nm. The combination of GNRs and 808 nm resulted in a 200% higher temperature rise than the 1064 nm under similar conditions. A computational model was developed to predict the temperature shift and was validated against experimental results with a deviation of <5%. These results show promise for both a predictive model and spatially selective, tunable treatment modality for pancreatic cancer.
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Affiliation(s)
- Forhad Akhter
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249, USA; (F.A.); (S.M.-B.); (A.L.S.); (Y.F.)
| | - Santiago Manrique-Bedoya
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249, USA; (F.A.); (S.M.-B.); (A.L.S.); (Y.F.)
| | - Chris Moreau
- Gastroenterology and Transplant, UT Health San Antonio, San Antonio, TX 78229, USA;
| | - Andrea Lynn Smith
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249, USA; (F.A.); (S.M.-B.); (A.L.S.); (Y.F.)
| | - Yusheng Feng
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249, USA; (F.A.); (S.M.-B.); (A.L.S.); (Y.F.)
| | - Kathryn M. Mayer
- Department of Physics & Astronomy, University of Texas at San Antonio, San Antonio, TX 78249, USA;
| | - R. Lyle Hood
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249, USA; (F.A.); (S.M.-B.); (A.L.S.); (Y.F.)
- Graduate School of Biomedical Sciences, UT Health San Antonio, San Antonio, TX 78229, USA
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10
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Truong VG, Kim H, Park JS, Tran VN, Kang HW. Multiple cylindrical interstitial laser ablations (CILAs) of porcine pancreas in ex vivo and in vivo models. Int J Hyperthermia 2021; 38:1313-1321. [PMID: 34472992 DOI: 10.1080/02656736.2021.1972171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The therapeutic capacity of multiple cylindrical interstitial laser ablations (CILAs) of pancreatic tissue was evaluated with 1064 nm laser light in ex vivo and in vivo porcine pancreatic models. METHODS A diffusing applicator was sequentially employed to deliver 1064 nm laser light in a cylindrical distribution to ablate a large volume of pancreatic tissue. Ex vivo tissue was tested at various power levels (5, 7, and 10 W) under US imaging. An in vivo porcine model was used to evaluate the clinical feasibility of multiple CILAs on pancreatic tissue at 5 W via laparotomy (N = 3). RESULTS Multiple CILAs symmetrically ablated a range of ex vivo tissue volumes (2.4-6.0 cm3) at various power levels. Multiple CILAs warranted a therapeutic capacity of symmetrically ablating in vivo pancreatic tissue. Both ex vivo and in vivo pancreatic tissues after multiple CILAs at 5 W confirmed the absence of or minimal thermal injury to the peripheral tissue and carbonization. CONCLUSIONS The current findings suggest that the collective thermal effects from multiple CILAs can help widely ablate pancreatic tissue with minimal thermal injury. Further in vivo studies will investigate the safety of the proposed CILA treatment as well as acute/chronic responses of pancreatic tissue for clinical translations.
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Affiliation(s)
- Van Gia Truong
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
| | - Hyeonsoo Kim
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Van Nam Tran
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
| | - Hyun Wook Kang
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea.,Department of Biomedical Engineering and Marine-Integrated Biomedical Technology Center, Pukyong National University, Busan, Republic of Korea
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11
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Truong VG, Jeong S, Park JS, Tran VN, Kim SM, Lee DH, Kang HW. Endoscopic ultrasound (EUS)-guided cylindrical interstitial laser ablation (CILA) on in vivo porcine pancreas. BIOMEDICAL OPTICS EXPRESS 2021; 12:4423-4437. [PMID: 34457423 PMCID: PMC8367258 DOI: 10.1364/boe.427379] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 05/27/2023]
Abstract
This study aims to demonstrate the feasibility of cylindrical interstitial laser ablation (CILA) in porcine pancreatic tissue to develop a EUS-guided PC ablation technique with enhanced safety. A diffusing applicator created a uniformly symmetrical laser ablation in pancreatic tissue. Ex vivo tests presented that both ablation thickness and volume increased linearly with the applied power (R2 = 0.96 and 0.90, respectively) without carbonization and fiber degradation. The numerical simulations matched well with the experimental results in terms of temperature development and thermal damage (deviation of ≤ 15%). In vivo tests with EUS confirmed easy insertion and high durability of the diffusing applicator. EUS-guided CILA warranted a feasible therapeutic capacity of ablating in vivo pancreatic tissue. The proposed EUS-guided CILA can be a feasible therapeutic approach to treat PC with predictable thermal ablation and enhanced safety.
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Affiliation(s)
- Van Gia Truong
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
- These authors contributed equally to this work
| | - Seok Jeong
- Department of Internal Medicine, Inha University School of Medicine, and the National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders, Inha University Hospital, Incheon, Republic of Korea
- These authors contributed equally to this work
| | - Jin-Seok Park
- Department of Internal Medicine, Inha University School of Medicine, and the National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders, Inha University Hospital, Incheon, Republic of Korea
| | - Van Nam Tran
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
| | - Sung Min Kim
- Bluecore Company, Inc., Busan, Republic of Korea
| | - Don Haeng Lee
- Department of Internal Medicine, Inha University School of Medicine, and the National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders, Inha University Hospital, Incheon, Republic of Korea
| | - Hyun Wook Kang
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
- Department of Biomedical Engineering, Pukyong National University, Busan, Republic of Korea
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12
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Abstract
Ablative therapies for locoregional treatment of pancreatic neoplastic lesions developed over the last decade to be applied during surgery are now becoming also available to be utilized under endoscopic ultrasound (EUS) guidance. The advantage of this approach is clear because of the close proximity of the EUS transducer to the target lesion, coupled with developments of specifically designed ablation devices, making the procedure minimally invasive, and potentially sparing patients from the morbidity of this method when performed surgically. EUS-guided ablative techniques that have been applied to pancreatic neoplastic cysts, pancreatic functional and non-functional neuroendocrine neoplasms and pancreatic ductal adenocarcinoma include ethanol injection, radiofrequency ablation (RFA), a combination of bipolar RFA and cryoablation, laser therapy (LT) and photodynamic therapy (PDT). Up to now, most of these procedures have been applied to patients at high surgical risk or who refused surgery. However, more studies evaluating some of these treatments also in selected patients not at surgical risk are becoming available. These studies will pave the road to apply this therapeutic approach to a more extensive number of patients, alone or in association with other therapies, such as immunomodulating drugs. The present manuscript will critically review the available evidence in the field of EUS-guided local ablative treatment of solid and cystic pancreatic neoplasms.
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Affiliation(s)
- Mihai Rimbaș
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.,Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy - .,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
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13
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Larghi A, Rimbaș M, Rizzatti G, Carbone C, Gasbarrini A, Costamagna G, Alfieri S, Tortora G. Endoscopic ultrasound-guided therapies for pancreatic solid tumors: An overview. Semin Oncol 2021; 48:95-105. [PMID: 33608132 DOI: 10.1053/j.seminoncol.2021.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 01/16/2021] [Indexed: 12/14/2022]
Abstract
The close proximity of the endoscopic ultrasound (EUS) probe to the pancreas, coupled with the ease with which a needle can be inserted into a pancreatic lesion, have contributed to the development of EUS-guided therapies for both adenocarcinoma and neuroendocrine pancreatic neoplasms. EUS-guided fine needle injection of different types of drugs, implantation of fiducial markers to facilitate stereotactic body radiation therapy or of radioactive seeds to perform brachytherapy, and the use of different thermal and nonthermal ablation devices and techniques have all been tested in preliminary human studies. This manuscript will present the available evidence accumulated thus far in the field of EUS-guided oncological treatment of pancreatic solid tumors, along with a look into possible future applications.
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Affiliation(s)
- Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Mihai Rimbaș
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Gastroenterology Division, Fondazione Policlinico Universitario A. Gemelli, Catholic University, IRCCS, Rome, Italy
| | - Carmine Carbone
- Oncological Division, Fondazione Policlinico Universitario A. Gemelli, Catholic University, IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Gastroenterology Division, Fondazione Policlinico Universitario A. Gemelli, Catholic University, IRCCS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University, Rome, Italy; IHU-USIAS, University of Strasbourg, Strasbourg, France
| | - Sergio Alfieri
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Giampaolo Tortora
- Oncological Division, Fondazione Policlinico Universitario A. Gemelli, Catholic University, IRCCS, Rome, Italy
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14
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DeWitt JM, Arain M, Chang KJ, Sharaiha R, Komanduri S, Muthusamy VR, Hwang JH. Interventional Endoscopic Ultrasound: Current Status and Future Directions. Clin Gastroenterol Hepatol 2021; 19:24-40. [PMID: 32950747 DOI: 10.1016/j.cgh.2020.09.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023]
Abstract
The evolution of endoscopic ultrasound (EUS) from a diagnostic to a therapeutic procedure has resulted in a paradigm shift toward endoscopic management of disease states that previously required percutaneous or surgical approaches. The past few years have seen additional techniques and devices that have enabled endoscopists to expand its diagnostic and therapeutic capabilities. Some of these techniques initially were reported more than a decade ago; however, with further device development and refinement in techniques there is potential for expanding the application of these techniques and new technologies to a broader group of interventional gastroenterologists. Lack of formalized training, devices, and prospective data regarding their use in addition to a scarcity of guidelines on implementation of these technologies into clinical practice are contributing factors impeding the growth of the field of interventional EUS. In April 2019, the American Gastroenterological Association's Center for Gastrointestinal Innovation and Technology conducted its annual Tech Summit and a key session focused on interventional EUS. This article is a White Paper generated from the conference, discusses the published literature pertaining to the topic of interventional EUS, and outlines a proposed framework for the implementation of interventional EUS techniques into clinical practice. Three primary areas of interventional EUS are addressed: (1) EUS-guided access; (2) EUS-guided tumor ablation; and (3) endohepatology. There was general agreement among participants on several key components. The introduction of these novel interventions requires better tools, more data on safety/outcomes, and improved training for endoscopists. Participants also agreed that widespread implementation and use of these techniques will require support from Gastrointestinal Societies and other key stakeholders including payers. Continued work by the Gastrointestinal Societies and manufacturers to provide training programs, appropriate equipment/work environments, and policies that motivate endoscopists to adopt new techniques is essential for growing the field of interventional EUS.
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Affiliation(s)
- John M DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana
| | - Mustafa Arain
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Kenneth J Chang
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, California
| | - Reem Sharaiha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Sri Komanduri
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California.
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15
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Tran VN, Truong VG, Lee YW, Kang HW. Effect of optical energy modulation on the thermal response of biological tissue: computational and experimental validations. BIOMEDICAL OPTICS EXPRESS 2020; 11:6905-6919. [PMID: 33408969 PMCID: PMC7747898 DOI: 10.1364/boe.404827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 05/04/2023]
Abstract
This study develops an energy modulation technique to attain a constant interstitial tissue temperature and to induce the predetermined thermal coagulation without carbonization in tissue. An optical diffuser was employed to deliver 1064 nm light to the biological tissue. The combined mode maintained the interstitial temperature at 70 °C for longer durations compared to the continuous wave mode. Coagulation volumes increased linearly with the time and met the predetermined treatment volume range (0.32-0.52 cm3) after the combined treatment for 100 s. The combined modulation can be a feasible modality to induce the predetermined extent of thermal coagulation for treating papillary thyroid microcarcinoma.
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Affiliation(s)
- Van Nam Tran
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, Republic of Korea
| | - Van Gia Truong
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, Republic of Korea
| | - Yong Wook Lee
- School of Electrical Engineering, Pukyong National University, Busan, Republic of Korea
| | - Hyun Wook Kang
- Department of Biomedical Engineering, Pukyong National University, Busan, Republic of Korea
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16
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Liu RQ, Liu JB, Duan SB, Cheng SG, Chang ZY, Cao HC, Cao GS, Li YQ, Li N, Zhang LZ. Dynamic prostatic and laser-ablated lesion volume change after transperineal laser ablation in canine: preliminary observation and its clinical significance. Int J Hyperthermia 2020; 37:1260-1267. [PMID: 33191810 DOI: 10.1080/02656736.2020.1842517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM The purpose of this study is to observe the volume change of prostate and laser-ablated lesions in the canine and to explore the mechanism and clinical significance through histopathology. MATERIALS AND METHODS Transperineal laser ablation (TPLA) was performed under the guidance of transrectal ultrasound (TRUS) in eight canines. Two canines were sacrificed 1 day and 1 week after TPLA, respectively. The remaining six canines were sacrificed after finishing transrectal contrast-enhanced ultrasound (TR-CEUS) at three phases. RESULTS The prostatic volumes immediately following TPLA and 1 week later were larger than before TPLA (20.1 ± 3.9 vs 17.1 ± 3.8 ml; 21.7 ± 3.6 vs 17.1 ± 3.8 ml, p < 0.05), but 1 month later, returned to the preoperative level (17.4 ± 3.2 ml). At three time points, the mean volumes of laser-ablated lesions at 3 W/600 J were 0.6 ± 0.2, 1.1 ± 0.4, and 1.7 ± 0.5 ml, respectively, while those of laser-ablated lesions at 3 W/1200 J were 1.2 ± 0.2, 1.6 ± 0.3, and 2.2 ± 0.5 ml, respectively. The mean volumes of laser-ablated lesions increased significantly over time after TPLA (p < 0.050). CONCLUSION The prostate volume transient enlarges after TPLA, which prompts for clinical application that it should prolong appropriately the duration of urinary catheterization to avoid acute urinary retention. Many inflammatory cells were observed in the laser-ablated lesions and adjacent normal prostate parenchyma through histopathology. It is speculated that the inflammatory response is involved in the progression of tissue damage.
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Affiliation(s)
- Rui-Qing Liu
- Department of Interventional Therapy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China.,Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Zhengzhou City, China
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Shao-Bo Duan
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Zhengzhou City, China.,Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China
| | - Si-Guo Cheng
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China
| | - Zhi-Yang Chang
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Zhengzhou City, China.,Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China
| | - Hui-Cun Cao
- Department of Interventional Therapy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China
| | - Guang-Shao Cao
- Department of Interventional Therapy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China
| | - Ya-Qiong Li
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Zhengzhou City, China.,Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China
| | - Na Li
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Zhengzhou City, China.,Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China
| | - Lian-Zhong Zhang
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Zhengzhou City, China.,Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, China
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17
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Korganbayev S, Orrico A, Bianchi L, De Landro M, Wolf A, Dostovalov A, Saccomandi P. Closed-Loop Temperature Control Based on Fiber Bragg Grating Sensors for Laser Ablation of Hepatic Tissue. SENSORS 2020; 20:s20226496. [PMID: 33203048 PMCID: PMC7697476 DOI: 10.3390/s20226496] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/27/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
Laser ablation (LA) of cancer is a minimally invasive technique based on targeted heat release. Controlling tissue temperature during LA is crucial to achieve the desired therapeutic effect in the organs while preserving the healthy tissue around. Here, we report the design and implementation of a real-time monitoring system performing closed-loop temperature control, based on fiber Bragg grating (FBG) spatial measurements. Highly dense FBG arrays (1.19 mm length, 0.01 mm edge-to-edge distance) were inscribed in polyimide-coated fibers using the femtosecond point-by-point writing technology to obtain the spatial resolution needed for accurate reconstruction of high-gradient temperature profiles during LA. The zone control strategy was implemented such that the temperature in the laser-irradiated area was maintained at specific set values (43 and 55 °C), in correspondence to specific radii (2 and 6 mm) of the targeted zone. The developed control system was assessed in terms of measured temperature maps during an ex vivo liver LA. Results suggest that the temperature-feedback system provides several advantages, including controlling the margins of the ablated zone and keeping the maximum temperature below the critical values. Our strategy and resulting analysis go beyond the state-of-the-art LA regulation techniques, encouraging further investigation in the identification of the optimal control-loop.
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Affiliation(s)
- Sanzhar Korganbayev
- Department of Mechanical Engineering, Politecnico di Milano Milan, 20133 Milano MI, Italy; (A.O.); (L.B.); (M.D.L.); (P.S.)
- Correspondence: ; Tel.: +39-348-776-1649
| | - Annalisa Orrico
- Department of Mechanical Engineering, Politecnico di Milano Milan, 20133 Milano MI, Italy; (A.O.); (L.B.); (M.D.L.); (P.S.)
| | - Leonardo Bianchi
- Department of Mechanical Engineering, Politecnico di Milano Milan, 20133 Milano MI, Italy; (A.O.); (L.B.); (M.D.L.); (P.S.)
| | - Martina De Landro
- Department of Mechanical Engineering, Politecnico di Milano Milan, 20133 Milano MI, Italy; (A.O.); (L.B.); (M.D.L.); (P.S.)
| | - Alexey Wolf
- Laboratory of Fiber Optics, Institute of Automation and Electrometry SB RAS, Novosibirsk 630090, Russia; (A.W.); (A.D.)
| | - Alexander Dostovalov
- Laboratory of Fiber Optics, Institute of Automation and Electrometry SB RAS, Novosibirsk 630090, Russia; (A.W.); (A.D.)
| | - Paola Saccomandi
- Department of Mechanical Engineering, Politecnico di Milano Milan, 20133 Milano MI, Italy; (A.O.); (L.B.); (M.D.L.); (P.S.)
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18
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Akhter F, Bascos GNW, Canelas M, Griffin B, Hood RL. Mechanical characterization of a fiberoptic microneedle device for controlled delivery of fluids and photothermal excitation. J Mech Behav Biomed Mater 2020; 112:104042. [PMID: 32927279 DOI: 10.1016/j.jmbbm.2020.104042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/17/2020] [Accepted: 08/14/2020] [Indexed: 01/18/2023]
Abstract
Current clinical approaches for treating pancreatic cancer have been demonstrated as ineffective at improving midterm survival. A primary obstacle to local drug delivery is the desmoplastic nature of the peritumoral environment, which acts as a significant barrier to circulating macromolecules. To address this need, our group presents a sharp fiberoptic microcatheter capable of accessing the pancreas through transduodenal endoscope and penetrating a tumor to locally co-deliver photothermal and fluid-based therapies. Experiments sought to characterize the mechanical penetration capabilities and fluid mechanics of the fiberoptic microneedle design. A refined off-center fusion splicing technique was developed for joining a multimode fiber to the annular core of a light-guiding capillary, allowing light transmission with minimal optical loss. A novel and frugal technique for assessing the penetration force of the microneedle was conducted in a bovine gelatin tissue phantom with a Young's modulus stiffer than the high range for pancratic tissue or tumor. Buckling forces for different microneedle lengths were measured and compared against theoretical values obtained from Euler's Critical Load equation under fixed-pinned column conditions. Hydraulic resistance of different capillary lengths was evaluated and compared against the theoretical values from Hagen-Poiseuille's law, allowing assessment of contributions from different segments of the device. The results demonstrated that the microcatheter can robustly and repeatably penetrate a soft tissue phantom chosen to be a conservative model of pancreatic tissue for penetration properties. Experiments showed that a 1.5 N insertion force was required for phantom penetration with a 45° beveled needle at a 5 mm unsupported length, while the critical buckling load was measured to be approximately 4 N. In addition, the design was demonstrated to efficiently transport 1064 nm light and aqueous fluids with a 70-75% light coupling efficiency and 12,200 Pa.s/μl hydraulic resistance, respectively. These findings motivate the FMD's further development as a treatment platform for pancreatic cancer.
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Affiliation(s)
- Forhad Akhter
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Gregg Neal W Bascos
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Max Canelas
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Bradley Griffin
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - R Lyle Hood
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX, USA; Graduate School of Biomedical Sciences, UT Health San Antonio, San Antonio, TX, USA.
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19
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A Comprehensive Narrative Review on the Evolving Role of Endoscopic Ultrasound in Focal Solid Liver Lesions Diagnosis and Management. Diagnostics (Basel) 2020; 10:diagnostics10090688. [PMID: 32932960 PMCID: PMC7554970 DOI: 10.3390/diagnostics10090688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
The implications of endoscopic ultrasound (EUS) have expanded considerably in recent years to cover more fields in invasive gastroenterology practice, as both an investigative and therapeutic modality. The utility of EUS in the diagnosis and management of focal liver lesions has gained a special attractiveness recently. The EUS probe proximity to the liver and its excellent spatial resolution enables real-time images coupled with several enhancement techniques, such as contrast-enhanced (CE) EUS. Aside from its notable capability to execute targeted biopsies and therapeutic interventions, EUS has developed into a hopeful therapeutic tool for the management of solid liver lesions. Herein, we provide a comprehensive state-of-the-art review on the efficacy and safety of EUS in the diagnosis and management of focal solid liver lesions. Medline/PubMed and Embase database searches were conducted by two separate authors (T.K. and W.S.), all relevant studies were assessed, and relevant data was extracted and fully reported. EUS-guided diagnosis of focal liver lesions by sonographic morphologic appearance and cytological and histopathological finding of biopsies obtained via fine needle aspiration/biopsy have been shown to significantly improve the diagnosis of solid liver lesions compared with traditional imaging tools. Similarly, EUS-guided treatment has been shown to consistently have excellent technical success, high efficacy, and minor adverse events. The evolving valuable evidences of EUS utility might satisfy the unmet need of optimizing management of focal solid liver lesions.
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20
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Testoni SGG, Healey AJ, Dietrich CF, Arcidiacono PG. Systematic review of endoscopy ultrasound-guided thermal ablation treatment for pancreatic cancer. Endosc Ultrasound 2020; 9:83-100. [PMID: 32295966 PMCID: PMC7279078 DOI: 10.4103/eus.eus_74_19] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The development of curvilinear-array EUS and EUS-guided fine-needle aspiration (EUS-FNA) has led these approaches to become interventional procedures rather than purely diagnostic, as a minimally invasive antitumor therapeutic alternative to radiological and surgical treatments. The possibility to accurately position needle devices and to reach a deep target like the pancreas gland under real-time imaging guidance has expanded the use of EUS to ablate tumors. Currently, a variety of probes specifically designed for EUS ablation are available, including radiofrequency, hybrid cryothermal ablation (combining radiofrequency with cryotechnology), photodynamic therapy, and laser ablation. To date, several studies have demonstrated the safety and feasibility of these ablation techniques in the pancreatic setting, but only a few small series on pancreatic thermal ablation under EUS guidance are available. EUS-guided thermal ablation is primarily used for pancreatic cancer. It is well suited to this disease because of its superior anatomical access compared with other imaging modalities and the dismal prognosis despite improvements in chemoradiotherapy and surgery in the management of pancreatic cancer. Other targets are pancreatic neuroendocrine tumors and pancreatic cystic neoplasms, which are curable by surgical resection, but some patients are poor surgical candidates or prefer conservative management. This is a literature review of previously published clinical studies on EUS-guided thermal ablative therapies. Data on the long-term efficacy of EUS-guided antitumor thermal ablation therapy and large prospective randomized studies are still needed to confirm the real clinical benefits of these techniques for the management of pancreatic neoplasms.
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Affiliation(s)
- Sabrina Gloria Giulia Testoni
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrew James Healey
- Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, Scotland
| | - Christoph F Dietrich
- Department of Internal Medicine, Hirslanden Hospitals Berne Beau Site, Salem and Permanence, Berne, Switzerland
| | - Paolo Giorgio Arcidiacono
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
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21
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Abstract
"Endoscopic ultrasound (EUS)-guided ablative therapies have advanced significantly and have led to experimental applications in locations that have been difficult to image and/or reach with percutaneous approaches, such as the caudate and left lobe of the liver. EUS-guided treatments of the liver are under development. The literature has shown that many percutaneous ablative techniques are readily adaptable for EUS. In this review, the authors discuss the current developments on EUS-guided ablation of liver tumors, including injection of sclerosants, thermal therapy, and EUS-guided portal injection of chemotherapy."
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Affiliation(s)
- Tiffany Chua
- Division of Gastroenterology and Hepatology, Mayo Clinic Phoenix, Phoeniz, AZ, USA
| | - Douglas O Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic Phoenix, Phoeniz, AZ, USA.
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22
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Nabi Z, Reddy DN. Endoscopic Palliation for Biliary and Pancreatic Malignancies: Recent Advances. Clin Endosc 2019; 52:226-234. [PMID: 30665289 PMCID: PMC6547342 DOI: 10.5946/ce.2019.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/17/2018] [Indexed: 02/06/2023] Open
Abstract
Malignancies of the pancreatobiliary system are usually unresectable at the time of diagnosis. As a consequence, a majority of these cases are candidates for palliative care. With advances in chemotherapeutic agents and multidisciplinary care, the survival rate in pancreatobiliary malignancies has improved. Therefore, there is a need to provide an effective and long-lasting palliative care for these patients. Endoscopic palliation is preferred to surgery as the former is associated with equal efficacy and reduced morbidity. The main role of endoscopic palliation in the vast majority of pancreatobiliary malignancies includes biliary and enteral stenting for malignant obstructive jaundice and gastric outlet obstruction, respectively. Recent advances in endoscopic palliation appear promising in imparting long-lasting relief of symptoms. Use of radiofrequency ablation and photodynamic therapy in malignant biliary obstruction has been shown to improve the survival rates as well as the patency of biliary stents. The emergence of endoscopic ultrasound (EUS) as a therapeutic tool has enhanced the capability of minimally invasive palliation in pancreatobiliary cancers. EUS is a valuable alternative to endoscopic retrograde cholangiopancreatography for the palliation of obstructive jaundice. More recently, EUS is emerging as an effective primary modality for biliary and gastric bypass.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India
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23
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Lee SH. [Endoscopic Treatment for Pancreatic Cystic Lesions]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:10-17. [PMID: 29361808 DOI: 10.4166/kjg.2018.71.1.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The decision of the appropriate treatment for pancreatic cystic lesions (PCLs) is becoming increasingly important as the number of incidentally found PCLs increases. A range of modalities have been attempted because there has been an increasing demand for minimally invasive treatment for PCLs due to the large burden of a surgical resection. Endoscopic treatment using endoscopic ultrasonography (EUS), a representative of minimally invasive therapy, can be categorized into two types: ablation therapy by the injection of drugs and topical thermal coagulative therapy through the high topical energy. A number of studies reported the feasibility and efficacy of these treatments; the most common is EUS-guided ablation for PCLS with ethanol alone or in combination with anticancer drugs. Although ablation therapies with drug injection have proven safety and feasibility, there is no consensus regarding the actual treatment effects and indications of these modalities. EUS-guided radiofrequency ablation was recently attempted as a representative method of local thermal coagulation, but further studies will be needed because of the lack of evidence of its feasibility and safety. In addition, a range of treatments for malignant tumors rather than PCLs have been attempted, such as EUS-guided photodynamic therapy, EUS-guided neodymium-doped yttrium aluminum garnet laser, and high-intensity focused ultrasound, based on the data from animal experiments. Through further study, endoscopic treatment is expected to become established as a useful treatment modality for PCLs.
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Affiliation(s)
- Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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DeLisi MP, Peterson AM, Lile LA, Noojin GD, Shingledecker AD, Stolarski DJ, Oian CA, Kumru SS, Thomas RJ. Suprathreshold laser injuries in excised porcine skin for millisecond exposures at 1070 nm. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-11. [PMID: 30550049 DOI: 10.1117/1.jbo.23.12.125001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Abstract
Skin injury response to near-infrared (NIR) laser radiation between the minimum visible lesion threshold and ablation onset is not well understood. This study utilizes a 1070-nm diode-pumped Yb-fiber laser to explore the response of excised porcine skin to high-energy exposures in the suprathreshold injury region without inducing ablation. Concurrent high-speed videography is employed to determine a dichotomous response for three progressive damage categories: observable surface distortion, surface bubble formation due to contained intracutaneous water vaporization, and surface bubble rupture during exposure. Median effective dose (ED50) values are calculated in these categories for 3- and 100-ms pulses with beam diameters (1 / e2) of 3 mm (28, 35, and 49 J / cm2) and 7 mm (96, 141, and 212 J / cm2), respectively. Double-pulse cases are secondarily investigated. Experimental data are compared with the maximum permissible exposure limits and ablation onset simulated by a one-dimensional multiphysics model. Logistic regression analysis predicted injury events with ∼90 % of accuracy. The distinction of skin response into progressive damage categories expands the current understanding of high-energy laser safety while underlining the unique biophysical effects during induced water phase change in tissue. These results prove to be useful in the diagnosis and treatment of NIR laser injuries.
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Affiliation(s)
| | | | - Lily A Lile
- 711th Human Performance Wing, Airman Systems Directorate, Bioeffects Division, Optical Radiation Bio, United States
| | - Gary D Noojin
- Engility Corp., JBSA Fort Sam Houston, Texas, United States
| | | | | | - Chad A Oian
- 711th Human Performance Wing, Airman Systems Directorate, Bioeffects Division, Optical Radiation Bio, United States
| | - Semih S Kumru
- 711th Human Performance Wing, Airman Systems Directorate, Bioeffects Division, Optical Radiation Bio, United States
| | - Robert J Thomas
- 711th Human Performance Wing, Airman Systems Directorate, Bioeffects Division, Optical Radiation Bio, United States
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Saccomandi P, Lapergola A, Longo F, Schena E, Quero G. Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies. Int J Hyperthermia 2018; 35:398-418. [PMID: 30428728 DOI: 10.1080/02656736.2018.1506165] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Pancreatic cancer is a challenging malignancy with low treatment option and poor life expectancy. Thermal ablation techniques were proposed as alternative treatment options, especially in advanced stages and for unfit-for-surgery patients. This systematic review describes the thermal ablative techniques -i.e., Laser (LA), Radiofrequency (RFA), Microwave (MWA) Ablation, High-Intensity Focused Ultrasound (HIFU) and cryoablation- available for pancreatic cancer treatment. Additionally, an analysis of the efficacy, complication rate and overall survival for each technique is conducted. MATERIAL AND METHODS This review collects the ex vivo, preclinical and clinical studies presenting the use of thermal techniques in the pancreatic cancer treatment, searched up to March 2018 in PubMed and Medline. Abstracts, letters-to-the-editor, expert opinions, reviews and non-English language manuscripts were excluded. RESULTS Sixty-five papers were included. For the ex vivo and preclinical studies, there are: 12 records for LA, 8 for RFA, 0 for MWA, 6 for HIFU, 1 for cryoablation and 3 for hybrid techniques. For clinical studies, 1 paper for LA, 14 for RFA, 1 for MWA, 17 for HIFU, 1 for cryoablation and 1 for hybrid techniques. CONCLUSIONS Important technological advances are presented in ex vivo and preclinical studies, as the real-time thermometry, nanotechnology and hybrid techniques to enhance the thermal outcome. Conversely, a lack of standardization in the clinical employment of the procedures emerged, leading to contrasting results on the safety and feasibility of some analyzed techniques. Uniform conclusions on the safety and feasibility of these techniques for pancreatic cancer will require further structured investigation.
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Affiliation(s)
- Paola Saccomandi
- a IHU-Strasbourg Institute of Image-Guided Surgery , Strasbourg , France.,b Departement of Mechanical Engineering, Politecnico di Milano , Milan , Italy
| | - Alfonso Lapergola
- a IHU-Strasbourg Institute of Image-Guided Surgery , Strasbourg , France.,c Università G. D'Annunzio , Chieti , Italy
| | - Fabio Longo
- a IHU-Strasbourg Institute of Image-Guided Surgery , Strasbourg , France.,d Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy
| | | | - Giuseppe Quero
- d Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy
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Feasibility of EUS-guided Nd:YAG laser ablation of unresectable pancreatic adenocarcinoma. Gastrointest Endosc 2018; 88:168-174.e1. [PMID: 29452076 DOI: 10.1016/j.gie.2018.02.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS EUS has become an interventional technique in which a needle may be used as a vehicle to deliver therapeutic agents. Laser ablation (LA) has been used to treat many primary and secondary neoplasms. This study aimed to assess the feasibility of EUS-guided LA for unresectable (UR) pancreatic cancer. METHODS Patients with stage IIb-III pancreatic cancer underwent EUS-guided LA. All patients were unresponsive to previous chemoradiotherapy. LA was performed by using a 300-μm flexible fiber preloaded onto a 22-gauge fine needle. A 1064-nm wavelength neodymium-yttrium aluminum garnet (Nd:YAG) laser light with different power settings of 2 W for 800 J, 1000 J, and 1200 J; 3 W for 800 J, 1000 J, and 1200 J; and 4 W for 800 J, 1000 J, and 1200 J was used. Each patient was treated with a single application of 1 of these settings. The application time of the power settings ranged from 200 to 600 seconds. RESULTS Nine patients (median age, 74.7; range 55-85) underwent Nd:Yag LA. The mean size of the focal lesion was 35.4 mm (range, 21-45). The ablation area, demonstrated by 24-hour CT, ranged from .4 cm3 (for the lower power setting of 2 W/800 J) to a maximum of 6.4 cm3 (for 4 W/1000 J). The procedure was completed in all 9 patients without adverse events. CONCLUSION In our human experience, EUS-guided LA was feasible and well tolerated in patients with UR pancreatic cancer.
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Dugarova RS, Berelavichus SV, Kaldarov AR, Gorin DS. [Physical minimally invasive treatment of pancreatic insulinoma]. Khirurgiia (Mosk) 2018:94-97. [PMID: 29697692 DOI: 10.17116/hirurgia2018494-97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R S Dugarova
- Vishnevsky Institute of Surgery of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - S V Berelavichus
- Vishnevsky Institute of Surgery of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - A R Kaldarov
- Vishnevsky Institute of Surgery of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - D S Gorin
- Vishnevsky Institute of Surgery of Healthcare Ministry of the Russian Federation, Moscow, Russia
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Jiang T, Tian G, Bao H, Chen F, Deng Z, Li J, Chai W. EUS dating with laser ablation against the caudate lobe or left liver tumors: a win-win proposition? Cancer Biol Ther 2018; 19:145-152. [PMID: 29303406 DOI: 10.1080/15384047.2017.1414760] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Endoscopic ultrasound (EUS) have been not only a diagnostic tool, but also available in interventional therapy, which often previously needed surgical approaches to achieve. The study aimed to evaluate the effectiveness and safety of EUS-guided Nd:YAG laser ablation in unresectable tumors of the caudate lobe and left liver. We discussed ten cases of the caudate lobe and left liver tumors underwent laser ablation with EUS guidance. And we also have reviewed previous publication of EUS-guided thermal ablation for liver tumors in several decade years. EUS-guided Nd:YAG laser ablation (LA) of these tumors were successfully completed in ten patients, who had favourable prognosis with no complications in two-month follow-up. Based on our early observations, this suggested that EUS-guided LA might be technically feasible in selected patients with tumors of the caudate lobe and left liver. However, the safety of this technique need to be further confirmed in the future and if possible larger, prospective trials.
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Affiliation(s)
- Tian'an Jiang
- a Department of Ultrasound Medicine , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.,b Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Guo Tian
- b Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.,c State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Haiwei Bao
- d Department of Hepatobiliary and Pancreatic Surgery , The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Fen Chen
- d Department of Hepatobiliary and Pancreatic Surgery , The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Zhuang Deng
- d Department of Hepatobiliary and Pancreatic Surgery , The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Ju Li
- d Department of Hepatobiliary and Pancreatic Surgery , The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Weilu Chai
- a Department of Ultrasound Medicine , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
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Koklu S, Basar O, Brugge WR. Endoscopic ultrasound guided tumor directed therapy and cyst ablation. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mukewar S, Muthusamy VR. Recent Advances in Therapeutic Endosonography for Cancer Treatment. Gastrointest Endosc Clin N Am 2017; 27:657-680. [PMID: 28918804 DOI: 10.1016/j.giec.2017.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Therapeutic endosonography (EUS) may play an important role in the management of cancers. EUS-guided fiducial placement has a high success rate and can aid in stereotactic radiotherapy. EUS-guided tumor ablation therapies can help in palliation of locally advanced tumors. EUS-guided antitumor injection seems to be feasible and safe in animals; initial human studies suffer from small sample size and lack of controls. Randomized, controlled trials have not shown benefit over conventional therapy. EUS celiac plexus neurolysis has gained popularity and is performed by interventional endosonographers. Large trials are needed to determine the most appropriate indications and overall usefulness of these therapies.
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Affiliation(s)
- Saurabh Mukewar
- The Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 330-37, Los Angeles, CA 90095, USA
| | - Venkataraman Raman Muthusamy
- The Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 330-37, Los Angeles, CA 90095, USA.
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The Emerging Role of Endoscopists in Treating Unresectable Pancreatic Cancer. Pancreas 2017; 46:839-849. [PMID: 28697122 DOI: 10.1097/mpa.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Pancreatic adenocarcinoma is the eighth leading cause of cancer deaths worldwide in men and ninth leading cause in women. Surgical resection offers the only chance of potential cure; however, only 9.4% of patients present at the localized, resectable stage, whereas the rest present at the locally advanced or metastatic, unresectable stages. Because of the guarded outcomes following systemic chemoradiation and the associated systemic toxicities, locoregional therapies have recently gained popularity. Various endoscopic techniques (endoscopic ultrasound [EUS]-guided ablative therapies, fine-needle instillation of antitumor agents, stereotactic body radiation therapy with EUS-guided fiducial marker placement, and EUS-guided brachytherapy) have been explored over the past several years. Endoscopic therapy plays a role in the treatment of unresectable pancreatic adenocarcinoma. Its minimal invasiveness and increased precision of delivering oncologic treatments under EUS guidance render it as a favorable option for patients who do not benefit from surgical resection. New endoscopic therapies are currently under investigation, and the emerging role of the endoscopist in the treatment of unresectable pancreatic cancer continues to grow.
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Abstract
Management of pancreatic cystic lesions relies on patients' clinical presentation, imaging, and endoscopic ultrasound. Current research in basic science, radiology, and endoscopy is evolving and making progress in this condition which is relatively common in the general population. This review focuses on the recent endoscopic ultrasound approaches to the diagnosis of these pancreatic disorders.
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Affiliation(s)
- Michael J Bartel
- Department of Medicine, Section of Gastroenterology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Massimo Raimondo
- Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Rea R, Di Matteo FM, Martino M, Pandolfi M, Saccomandi P, Rabitti C, Crescenzi A, Costamagna G. Endoluminal Nd:YAG laser application in ex vivo biliary porcine tissue. Lasers Med Sci 2017; 32:1411-1415. [DOI: 10.1007/s10103-017-2264-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 06/12/2017] [Indexed: 12/16/2022]
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Bai Z, Shi Y, Wang J, Qiu L, Teng G, Zhang F, Yang X. Multi-modality imaging-monitored creation of rat orthotopic pancreatic head cancer with obstructive jaundice. Oncotarget 2017; 8:54277-54284. [PMID: 28903340 PMCID: PMC5589579 DOI: 10.18632/oncotarget.17347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate the feasibility of using multi-modality imaging to monitor the creation of rat models with orthotopic pancreatic head cancer with obstructive jaundice. Results 27 of 52 rats (51.92%) developed pancreatic head cancer. The tumor formation rate was significantly higher in the animal group receiving bioluminescent tumor, compared to the group receiving non-bioluminescent donor tumors [78.1% (25/32 rats) vs 10.0% (2/20 rats), P = 0.0001]. Both ultrasound imaging and MRI clearly characterized the orthotopic tumors. Laboratory biochemistry test for those rats with obstructive jaundice showed elevated levels of bilirubin, aspartate transaminase (AST), alkaline phosphatase (ALT) and gamma-glutamyl transpeptidase (λ-GGT), compared with those rats without jaundice (P < 0.05). Correlative pathology confirmed that all tumors were ductal adenocarcinomas, and located in pancreatic head regions. Materials and Methods Rat pancreatic adenocarcinoma cells (DSL-6A/C1) were first transfected with lentivirus/mCherry-luciferase genes, and then subcutaneously implanted into flanks of donor immunocompetent Lewis rats, to create pancreatic tumor tissues. The tumor tissues from donor rats with either bioluminescence signal or without the signal were then transplanted into the pancreatic heads of 52 recipient Lewis rats. Bioluminescence optical and ultrasound imaging, as well as magnetic resonance imaging (MRI), were performed to follow up the tumor formation and growth in these tumor-transplanted rats. Physical examination and biochemistry test were used to discern the rats with obstructive jaundice. The rats were euthanized for subsequent histologic correlation and confirmation. Conclusions We successfully created a new rat model with orthotopic pancreatic head cancer, which can be accurately monitored and visualized by different imaging modalities.
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Affiliation(s)
- Zhibin Bai
- Image-Guided Biomolecular Intervention Research, Section of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.,Department of Radiology, Zhongda Hospital, Southeastern University, Nanjing, China
| | - Yaoping Shi
- Image-Guided Biomolecular Intervention Research, Section of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jianfeng Wang
- Image-Guided Biomolecular Intervention Research, Section of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Longhua Qiu
- Image-Guided Biomolecular Intervention Research, Section of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Gaojun Teng
- Department of Radiology, Zhongda Hospital, Southeastern University, Nanjing, China
| | - Feng Zhang
- Image-Guided Biomolecular Intervention Research, Section of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Xiaoming Yang
- Image-Guided Biomolecular Intervention Research, Section of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.,Department of Radiology, Sir Run Run Show Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Tian G, Jiang T. US-guided percutaneous laser ablation of refractory metastatic retroperitoneal lesions: A care-compliant case report. Medicine (Baltimore) 2017; 96:e6597. [PMID: 28403099 PMCID: PMC5403096 DOI: 10.1097/md.0000000000006597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Retroperitoneal metastatic lymph node is rare but severe, which has important structures like the gastrointestinal tract and large blood vessels around and may challenge excision, inducing serious complications like hemorrhage, intestinal adhesion, and even death after injury. PATIENT CONCERNS We described the case of a 60-year-old man with a history of right liver resection in 2010, pulmonary wedge resection in 2012, and transarterial chemoembolization twice in 2014, in which the postoperative pathology suggested the mixed liver cancer, and poorly differentiated lung cancer from liver metastasis. DIAGNOSES Preoperative magnetic resonance (MR) imaging scan showed a refractory retroperitoneal metastatic lymph node. INTERVENTIONS Then this patient repeatedly received 4 ablations with US-guided laser ablation within a month. OUTCOMES After 4 ablations due to residual tumor, MR, and CT images of 5-month follow-up showed the partial response. No obvious side effects were discovered in this case during these procedures. LESSONS This suggested US-guided laser ablation appears to be a useful technique for retroperitoneal metastatic lymph node with poor general condition or those refusing surgical therapy.
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Affiliation(s)
- Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Tian’an Jiang
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
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Signoretti M, Valente R, Repici A, Delle Fave G, Capurso G, Carrara S. Endoscopy-guided ablation of pancreatic lesions: Technical possibilities and clinical outlook. World J Gastrointest Endosc 2017; 9:41-54. [PMID: 28250896 PMCID: PMC5311472 DOI: 10.4253/wjge.v9.i2.41] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/12/2016] [Accepted: 12/09/2016] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)-guided ablation procedures are emerging as a minimally invasive therapeutic alternative to radiological and surgical treatments for locally advanced pancreatic cancer (LAPC), pancreatic neuroendocrine tumours (PNETs), and pancreatic cystic lesions (PCLs). The advantages of treatment under endoscopic control are the real-time imaging guidance and the possibility to reach a deep target like the pancreas. Currently, radiofrequency probes specifically designed for ERCP or EUS ablation are available as well as hybrid cryotherm probe combining radiofrequency with cryotechnology. To date, many reports and case series have confirmed the safety and feasibility of that kind of ablation technique in the pancreatic setting. Moreover, EUS-guided fine-needle injection is emerging as a method to deliver ablative and anti-tumoral agents inside the tumuor. Ethanol injection has been proposed mostly for the treatment of PCLs and for symptomatic functioning PNETs, and the use of gemcitabine and paclitaxel is also interesting in this setting. EUS-guided injection of chemical or biological agents including mixed lymphocyte culture, oncolytic viruses, and immature dendritic cells has been investigated for the treatment of LAPC. Data on the long-term efficacy of these approaches, and large prospective randomized studies are needed to confirm the real clinical benefits of these techniques for the management of pancreatic lesions.
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Moris M, Atar M, Kadayifci A, Krishna M, Librero A, Richie E, Brugge W, Wallace MB. Thermal ablation of pancreatic cyst with a prototype endoscopic ultrasound capable radiofrequency needle device: A pilot feasibility study. Endosc Ultrasound 2017; 6:123-130. [PMID: 28440238 PMCID: PMC5418965 DOI: 10.4103/eus.eus_6_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pancreatic cysts are evaluated by endoscopic ultrasound and fine needle aspiration (EUS). The only accepted treatment is pancreatectomy, which is associated with morbidity and mortality. This study evaluated the optimal thermal dosimetry of a novel radiofrequency ablation device using a standard electrosurgical unit in ex vivo cyst models. METHODS A modified EUS 22-gauge monopolar needle prototype with a tip electrode connected to a standard electrosurgical unit (Erbe USA, Marietta, GA, USA) was used to induce a subboiling point temperature. A cyst model was created using 2-cm sections of porcine small intestine ligated and filled with saline. After ablation, the cyst models were prepared for pathological evaluation. The epithelial layers were measured in at least two different sites with a micrometer and compared with the corresponding control sample. RESULTS Thirty-two cyst models were ablated with maximum temperatures of 50°C, 60°C, 90°C, and 97°C in 8, 11, 11, and 2 cysts, respectively. Longer ablation times were required to induce higher temperatures. A trend in the reduction in thickness of the measured layers was observed after exposure to higher temperatures. A temperature over 50°C was required for the ablation of the muscularis, submucosa, and villi, and over 60°C was required to ablate the mucosal crypts. CONCLUSIONS In a preclinical model, a novel radiofrequency EUS-capable needle connected to a standard electrosurgical unit using standard low-voltage coagulation provided ablation in a temperature-dependent fashion with a threshold of at least 60°C and a safe cyst margin below 97°C. This potentially will allow low-cost, convenient cyst ablation.
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Affiliation(s)
- Maria Moris
- Division of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA
| | - Mustafa Atar
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Murli Krishna
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Ariston Librero
- Division of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA
| | - Eugene Richie
- J. Wayne and Delores Barr Weaver Simulation Center, Mayo Clinic, Jacksonville, FL, USA
| | - William Brugge
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
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Affiliation(s)
- Emanuele Dabizzi
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
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Detection of the Single-Session Complete Ablation Rate by Contrast-Enhanced Ultrasound during Ultrasound-Guided Laser Ablation for Benign Thyroid Nodules: A Prospective Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9565364. [PMID: 27999819 PMCID: PMC5141549 DOI: 10.1155/2016/9565364] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/08/2016] [Accepted: 11/07/2016] [Indexed: 01/22/2023]
Abstract
This study aimed to investigate the single-session complete ablation rate of ultrasound-guided percutaneous laser ablation (LA) for benign thyroid nodules. LA was performed in 90 patients with 118 benign thyroid nodules. Contrast-enhanced ultrasound (CEUS) was used to evaluate complete nodule ablation one day after ablation. Thyroid nodule volumes, thyroid functions, clinical symptoms and complications were evaluated 1, 3, 6, 12, and 18 months after ablation. Results showed that all benign thyroid nodules successfully underwent LA. The single-session complete ablation rates for nodules with maximum diameters ≤2 cm, 2-3 cm and ≥3 cm were 93.4%, 70.3% and 61.1%, respectively. All nodule volumes significantly decreased than that one day after ablation (P < 0.05); at the final evaluation, the volume decreased from 6.16 ± 5.21 mL to 0.05 ± 0.01 mL. Thyroid functions did not show significant differences at one month after ablation compared with that before (P > 0.05). Three patients had obvious pain during ablation; one (1.1%) had recurrent laryngeal nerve injury, but the voice returned to normal within 6 months after treatment. Thus, ultrasound-guided LA can effectively inactivate benign thyroid nodules. LA is a potentially viable minimally invasive treatment that offers good cosmetic effects.
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Arshad HMS, Bharmal S, Duman DG, Liangpunsakul S, Turner BG. Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions. J Investig Med 2016; 65:7-14. [PMID: 27574295 PMCID: PMC5284342 DOI: 10.1136/jim-2016-000167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 12/13/2022]
Abstract
Pancreatic cystic lesions can be benign, premalignant or malignant. The recent increase in detection and tremendous clinical variability of pancreatic cysts has presented a significant therapeutic challenge to physicians. Mucinous cystic neoplasms are of particular interest given their known malignant potential. This review article provides a brief but comprehensive review of premalignant pancreatic cystic lesions with advanced endoscopic ultrasound (EUS) management approaches. A comprehensive literature search was performed using PubMed, Cochrane, OVID and EMBASE databases. Preneoplastic pancreatic cystic lesions include mucinous cystadenoma and intraductal papillary mucinous neoplasm. The 2012 International Sendai Guidelines guide physicians in their management of pancreatic cystic lesions. Some of the advanced EUS management techniques include ethanol ablation, chemotherapeutic (paclitaxel) ablation, radiofrequency ablation and cryotherapy. In future, EUS-guided injections of drug-eluting beads and neodymium:yttrium aluminum agent laser ablation is predicted to be an integral part of EUS-guided management techniques. In summary, International Sendai Consensus Guidelines should be used to make a decision regarding management of pancreatic cystic lesions. Advanced EUS techniques are proving extremely beneficial in management, especially in those patients who are at high surgical risk.
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Affiliation(s)
- Hafiz Muhammad Sharjeel Arshad
- Department of Internal Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Sheila Bharmal
- Department of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Deniz Guney Duman
- Department of Gastroenterology, Marmara University, Istanbul, Turkey
| | - Suthat Liangpunsakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Estimation of optical properties of neuroendocrine pancreas tumor with double-integrating-sphere system and inverse Monte Carlo model. Lasers Med Sci 2016; 31:1041-50. [PMID: 27147075 DOI: 10.1007/s10103-016-1948-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/25/2016] [Indexed: 02/05/2023]
Abstract
The investigation of laser-tissue interaction is crucial for diagnostics and therapeutics. In particular, the estimation of tissue optical properties allows developing predictive models for defining organ-specific treatment planning tool. With regard to laser ablation (LA), optical properties are among the main responsible for the therapy efficacy, as they globally affect the heating process of the tissue, due to its capability to absorb and scatter laser energy. The recent introduction of LA for pancreatic tumor treatment in clinical studies has fostered the need to assess the laser-pancreas interaction and hence to find its optical properties in the wavelength of interest. This work aims at estimating optical properties (i.e., absorption, μ a , scattering, μ s , anisotropy, g, coefficients) of neuroendocrine pancreas tumor at 1064 nm. Experiments were performed using two popular sample storage methods; the optical properties of frozen and paraffin-embedded neuroendocrine tumor of the pancreas are estimated by employing a double-integrating-sphere system and inverse Monte Carlo algorithm. Results show that paraffin-embedded tissue is characterized by absorption and scattering coefficients significantly higher than frozen samples (μ a of 56 cm(-1) vs 0.9 cm(-1), μ s of 539 cm(-1) vs 130 cm(-1), respectively). Simulations show that such different optical features strongly influence the pancreas temperature distribution during LA. This result may affect the prediction of therapeutic outcome. Therefore, the choice of the appropriate preparation technique of samples for optical property estimation is crucial for the performances of the mathematical models which predict LA thermal outcome on the tissue and lead the selection of optimal LA settings.
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Kaplan J, Khalid A, Cosgrove N, Soomro A, Mazhar SM, Siddiqui AA. Endoscopic ultrasound-fine needle injection for oncological therapy. World J Gastrointest Oncol 2015; 7:466-72. [PMID: 26691224 PMCID: PMC4678393 DOI: 10.4251/wjgo.v7.i12.466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/11/2015] [Accepted: 10/12/2015] [Indexed: 02/05/2023] Open
Abstract
The minimal invasiveness and precision of endoscopic ultrasound (EUS) has lead to both its widespread use as a diagnostic and staging modality for gastrointestinal and pancreaticobiliary malignancies, and to its expanding role as a therapeutic modality. EUS-guided celiac plexus neurolysis is now a well-accepted modality for palliation of pain in patients with pancreatic cancer. EUS-guided ablation, brachytherapy, fiducial marker placement, and antitumor agent injection have been described as methods of performing minimally invasive oncological therapy. EUS-fine needle injection may be performed as adjunctive, alternative, or palliative treatment. This review summarizes the studies to date that have described these methods. A literature search using the PubMed/MEDLINE databases was performed. While most published studies to date are limited with disappointing outcomes, the concept of a role of EUS in oncological therapy seems promising.
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Takakura K, Koido S. Direct therapeutic intervention for advanced pancreatic cancer. World J Clin Oncol 2015; 6:216-219. [PMID: 26677434 PMCID: PMC4675906 DOI: 10.5306/wjco.v6.i6.216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/21/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Currently, chemotherapy is an accredited, standard treatment for unresectable, advanced pancreatic cancer (PC). However, it has been still showed treatment-resistance and followed dismal prognosis in many cases. Therefore, some sort of new, additional treatments are needed for the better therapeutic results for advanced PC. According to the previous reports, it is obvious that interventional endoscopic ultrasonography (EUS) is a well-established, helpful and low-risky procedure in general. As the additional treatments of the conventional therapy for advanced PC, many therapeutic strategies, such as immunotherapies, molecular biological therapies, physiochemical therapies, radioactive therapies, using siRNA, using autophagy have been developing in recent years. Moreover, the efficacy of the other potential therapeutic targets for PC using EUS-fine needle injection, for example, intra-tumoral chemotherapeutic agents (paclitaxel, irinotecan), several ablative energies (radiofrequency ablation and cryothermal treatment, neodymium-doped yttrium aluminum garnet laser, high-intensity focused ultrasound), etc., has already been showed in animal models. Delivering these promising treatments reliably inside tumor, interventional EUS may probably be indispensable existence for the treatment of locally advanced PC in near future.
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Yoon WJ, Seo DW. [Endoscopic Ultrasound-guided Local Therapy of Pancreatic Tumors]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 66:154-8. [PMID: 26387698 DOI: 10.4166/kjg.2015.66.3.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The development of curvilinear EUS has enabled EUS-guided fine-needle aspiration of intra-abdominal mass lesions. With the introduction of interventional EUS, this technology has undergone several modifications in order to be applied to clinical medicine. One of the potential uses of interventional EUS is the EUS-guided local therapy of pancreatic tumors. Various treatment modalities such as fine-needle injection, radiofrequency ablation, photodynamic therapy, laser ablation, and brachytherapy have been tried under EUS guidance. Some of these modalities are being applied clinically. These methods for EUS-guided local therapy of pancreatic tumors will be reviewed in this article.
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Affiliation(s)
- Won Jae Yoon
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Dong Wan Seo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Endoscopic ultrasound-guided therapies in pancreatic neoplasms. BIOMED RESEARCH INTERNATIONAL 2015; 2015:731049. [PMID: 25802863 PMCID: PMC4329839 DOI: 10.1155/2015/731049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/22/2014] [Accepted: 12/25/2014] [Indexed: 12/18/2022]
Abstract
Endoscopic ultrasound (EUS) has evolved from being primarily a diagnostic modality into an interventional endoscopic tool for the management of both benign and malignant gastrointestinal illnesses. EUS-guided therapy has garnered particular interest as a minimally invasive approach for the treatment of pancreatic cancer, a disease often complicated by its aggressive course and poor survival. The potential advantage of an EUS-guided approach revolves around real-time imaging for targeted therapy of a difficult to reach organ. In this review, we focus on EUS-guided therapies for pancreatic neoplasms.
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Ende AR, Hwang JH. Endoscopic ultrasound-guided tumor ablation. GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OPINION STATEMENT Endoscopic ultrasound (EUS) is not only a diagnostic tool but also an interventional and therapeutic procedure. Indeed, in addition to tissue acquisition, it can also drain fluid collections adjacent to the gastrointestinal tract, provide access to biliary and pancreatic ducts, biliary, pancreatic, and gallbladder drainage, pancreatic cyst ablation, and, finally, provide anti-tumoral treatments and interventional vascular procedures. Although several improvements have been made in the last decade, the full potential of interventional EUS is yet to be completely explored. Future areas of research are the development of dedicated tools and accessories, the standardization of the interventional procedures, and the widening of the use of EUS, while increasing the expertise worldwide. In addition, more data, based on well-performed, possibly randomized clinical trials, are needed to accurately determine the risks and long-term outcomes of these interventions. We firmly believe that interventional EUS can play a pivotal role in anti-tumor treatments, by the fine-needle injection of anti-tumoral agents, tumor ablation, and assisting radiation treatment with gold fiducial placement and the implantation of intralesional seeds. The goal of the near future will be to offer targeted therapy and monitoring of tumor treatment response in a more biologically driven manner than has been available in the past. Interventional EUS will be an essential part of the multidisciplinary approach to cancer treatment.
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Keane MG, Bramis K, Pereira SP, Fusai GK. Systematic review of novel ablative methods in locally advanced pancreatic cancer. World J Gastroenterol 2014; 20:2267-78. [PMID: 24605026 PMCID: PMC3942832 DOI: 10.3748/wjg.v20.i9.2267] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/11/2013] [Accepted: 01/08/2014] [Indexed: 02/06/2023] Open
Abstract
Unresectable locally advanced pancreatic cancer with or without metastatic disease is associated with a very poor prognosis. Current standard therapy is limited to chemotherapy or chemoradiotherapy. Few regimens have been shown to have a substantial survival advantage and novel treatment strategies are urgently needed. Thermal and laser based ablative techniques are widely used in many solid organ malignancies. Initial studies in the pancreas were associated with significant morbidity and mortality, which limited widespread adoption. Modifications to the various applications, in particular combining the techniques with high quality imaging such as computed tomography and intraoperative or endoscopic ultrasound has enabled real time treatment monitoring and significant improvements in safety. We conducted a systematic review of the literature up to October 2013. Initial studies suggest that ablative therapies may confer an additional survival benefit over best supportive care but randomised studies are required to validate these findings.
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Di Matteo F, Martino M, Rea R, Pandolfi M, Panzera F, Stigliano E, Schena E, Saccomandi P, Silvestri S, Pacella CM, Breschi L, Perrone G, Coppola R, Costamagna G. US-guided application of Nd:YAG laser in porcine pancreatic tissue: an ex vivo study and numerical simulation. Gastrointest Endosc 2013; 78:750-5. [PMID: 23680175 DOI: 10.1016/j.gie.2013.04.178] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/15/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laser ablation (LA) with a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is a minimally invasive approach able to achieve a high rate of complete tissue necrosis. In a previous study we described the feasibility of EUS-guided Nd:YAG pancreas LA performed in vivo in a porcine model. OBJECTIVE To establish the best laser setting of Nd:YAG lasers for pancreatic tissue ablation. A secondary aim was to investigate the prediction capability of a mathematical model on ablation volume. DESIGN Ex vivo animal study. SETTING Hospital animal laboratory. SUBJECTS Explanted pancreatic glands from 60 healthy farm pigs. INTERVENTION Laser output powers (OP) of 1.5, 3, 6, 10, 15, and 20 W were supplied. Ten trials for each OP were performed under US guidance on ex vivo healthy porcine pancreatic tissue. MAIN OUTCOME MEASUREMENTS Ablation volume (Va) and central carbonization volume (Vc) were measured on histologic specimens as the sum of the lesion areas multiplied by the thickness of each slide. The theoretical model of the laser-tissue interaction was based on the Pennes equation. RESULTS A circumscribed ablation zone was observed in all histologic specimens. Va values grow with the increase of the OP up to 10 W and reach a plateau between 10 and 20 W. The trend of Vc values rises constantly until 20 W. The theoretical model shows a good agreement with experimental Va and Vc for OP between 1.5 and 10 W. LIMITATIONS Ex vivo study. CONCLUSION Volumes recorded suggest that the best laser OP could be the lowest one to obtain similar Va with smaller Vc in order to avoid the risk of thermal injury to the surrounding tissue. The good agreement between the two models demonstrates the prediction capability of the theoretical model on laser-induced ablation volume in an ex vivo animal model and supports its potential use for estimating the ablation size at different laser OPs.
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Guo X, Cui Z, Hu Z. Role of endoscopic ultrasound in treatment of pancreatic cancer. Endosc Ultrasound 2013; 2:181-9. [PMID: 24949393 PMCID: PMC4062275 DOI: 10.4103/2303-9027.121238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/24/2013] [Indexed: 12/14/2022] Open
Abstract
Endoscopic ultrasound (EUS) can help diagnose diseases with high accuracy because it overcomes the limitations of gastrointestinal gas and abdominal fat. The emergence of curved linear-array echoendoscopy has significantly promoted the applications of the technique to new levels. The advancement has appeared from EUS imaging to EUS-guided fine needle aspiration, drainage and injection. Computed tomography and magnetic resonance imaging present certain limitations for diagnosing pancreatic tumors due to the specificity of the location of such growths. In addition, traditional chemotherapy does not show ideal results because pancreatic cancer (PC) exhibits hypovascular characteristics. Interventional EUS can overcome these limitations and has potential to become the mainstream method of PC local treatment in the future. This paper reviews the use of interventional EUS in the treatment of PC based on previous studies.
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Affiliation(s)
- Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Shenyang Military Command, Shenyang 110840, Liaoning Province, China
| | - Zhongmin Cui
- Department of Gastroenterology, General Hospital of Shenyang Military Command, Shenyang 110840, Liaoning Province, China
| | - Zhigang Hu
- Department of Gastroenterology, General Hospital of Shenyang Military Command, Shenyang 110840, Liaoning Province, China
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