US-guided application of a new hybrid probe in human pancreatic adenocarcinoma: an ex vivo study

doi:10.1016/j.gie.2010.02.014

Gastrointestinal Endoscopy

Volume 71, Issue 7, June 2010, Pages 1294-1297

https://doi.org/10.1016/j.gie.2010.02.014 Get rights and content

Background

Ablative therapies such as radiofrequency and cryotechnology are widely used in oncological intervention but not in the pancreatic field because of their high operative risks. A new flexible bipolar ablation device (Cryotherm probe [CTP]) was developed combining radiofrequency and cryotechnology.

Objective

To evaluate the efficacy of the CTP in destroying neoplastic tissue of explanted pancreatic tumors of patients with pancreatic adenocarcinoma.

Design

Ex vivo clinical study.

Setting

Inpatient hospital setting.

Patients

This study involved 16 explanted pancreatic tumors from 16 patients.

Interventions

CTP application was performed on explanted pancreatic tumors. Anatomic specimens were divided into 4 groups; each group received a predefined application time of 120 to 600 seconds.

Main Outcome Measurements

The coagulation diameter (short axis) perpendicular to the device's longitudinal axis was used as the primary outcome measure.

Results

All pancreatic specimens showed histological signs of coagulative necrosis. There was a positive correlation between the short axis of the obtained necrosis and duration of application (r = 0.74).

Limitations

This study was an ex vivo study with all limitations typical of this kind of study.

Conclusions

The CTP is effective in destroying neoplastic pancreatic tissue, creating an ablation zone, the extent of which is related to the duration of application.

Section snippets

Patients and methods

Sixteen patients (8 men, age 59 ± 13 years) who underwent pancreatic resection were enrolled. The study protocol was approved by the institutional review board of Scientific Institute San Raffaele (number CTP ex vivo 2007).

Immediately after resection, pancreatic specimens were treated by CTP. Surface real-time US was used to guide the CTP into the tumor by using a 7.5- to 10-MHz probe (Fig. 3). During application, a hyperechoic area appeared around the distal tip (diameter of the active part

Results

The tumor size was 29 ± 9 mm (range 20-42 mm). All 16 pancreatic specimens were related to adenocarcinoma and showed histological signs of coagulative necrosis. The ablated area was restricted to within the tumor.

Histological analysis of the specimens showed 2 different areas: the first with defined coagulative necrosis (zone A) and the second with edema and cellular damage, but with no signs of cellular death (zone B) (Fig. 4).

The diameter of the mean short axis of the zone A, varied from 10

Discussion

RFA of pancreatic tumors bears a major risk of thermal injury to important adjacent structures such as the bile duct, the duodenum, and the larger vessels around the pancreas. The CTP is the first device to combine RF and cryotechnology and was designed to be used under EUS guidance. This new device was developed to achieve the maximum ablation size within the shortest time technically possible, which is especially important for endoscopic therapies in the clinical setting. We applied the CTP

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The firm position during the treatment was helpful in controlling the ablation area and avoiding sonographic artifacts. According to the previous studies6-8 and to the distance between the electrodes of the active part of the probe, a tumor size with a longitudinal axis ≥2 cm was eligible for inclusion into the study. There were no restrictions to location within the pancreas.
New therapies are needed for pancreatic cancer.
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A cohort study of patients with local progression of advanced pancreatic adenocarcinoma after neoadjuvant therapy. The cryotherm probe (CTP), a flexible bipolar device that combines radiofrequency with cryogenic cooling, was used under EUS guidance.
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: DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: M.C. Petrone: Grant support from ERBE Elektromedizin GmbH. M.D. Enderle: Employee of ERBE Elektromedizin GmbH. A. Neugebauer: Employee of ERBE Elektromedizin GmbH. The other authors disclosed no financial relationships relevant to this publication.

: If you would like to chat with an author of this article, you may contact Dr. Petrone at [email protected].

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New methodExperimental endoscopyUS-guided application of a new hybrid probe in human pancreatic adenocarcinoma: an ex vivo study

Background

Objective

Design

Setting

Patients

Interventions

Main Outcome Measurements

Results

Limitations

Conclusions

Section snippets

Patients and methods

Results

Discussion

J Am Coll Surg

J Vasc Interv Radiol

Global cancer statistics 2002

CA Cancer J Clin

Radiofrequency ablation of solid tumors

Cancer J

New method
Experimental endoscopy
US-guided application of a new hybrid probe in human pancreatic adenocarcinoma: an ex vivo study