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Endoscopy 2014; 46(05): 411-415
DOI: 10.1055/s-0034-1364933
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided lymph node ablation with a novel radiofrequency ablation probe: feasibility study in an acute porcine model

Amrita Sethi   *
1   Columbia University Medical Center, New York, New York, USA
,
Mark Ellrichmann   *
2   Unit of Experimental Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Kiel, Germany
,
Shantiswaroop Dhar
2   Unit of Experimental Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Kiel, Germany
,
Klaus-Gerd Hadeler
3   Institute for Animal Breeding, Friedrich-Löffler Institute, Mariensee, Germany
,
Erich Kahle
3   Institute for Animal Breeding, Friedrich-Löffler Institute, Mariensee, Germany
,
Frauke Seehusen
4   Department of Pathology, Veterinarian University Medical School, Hannover, Germany
,
Wolfram Klapper
5   Institue of Pathology, Hemapathology Section and lymph Node Registry, University Hospital Schleswig-Holstein, Kiel, Germany
,
Nagy Habib
6   Department of Surgery, Hammersmith Hospital, London, United Kingdom
,
Annette Fritscher-Ravens
2   Unit of Experimental Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Kiel, Germany
› Author Affiliations
Further Information

Publication History

submitted24 April 2013

accepted after revision 16 December 2013

Publication Date:
06 February 2014 (online)

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Background and study aims: Radiofrequency ablation (RFA) is an accepted method of tissue destruction for solid organ tumors. Endoscopic ultrasound (EUS)-guided RFA has been used for lesions in the pancreas and liver, but there is limited experience of lymph node ablation using EUS-guided RFA. The aim of this study was to determine feasibility and safety of prototype EUS-guided RFA of mediastinal lymph nodes.

Methods: This was an endoscopic experimental feasibility study in a porcine model. After EUS-guided puncture of targeted lymph nodes, the stylet of a 19-G needle was replaced by a prototype RFA probe. RFA was performed by ERBE generator (bipolar settings: 10 watts, effect 2, 2 minutes). The animals were euthanized, and the targeted lymph nodes were identified and removed for histology and measurement of the effect achieved.

Results: A total of 18 mediastinal lymph nodes were ablated (mean size 20.8 ± 6.6 mm in the long axis). The average length of exposed probe was 10.0 ± 3.0 mm. The mean length and diameter of necrosis was 9.8 ± 3.6 mm and 5.5 ± 1.6 mm, respectively. Linear regression comparing needle length with necrosis diameter revealed a coefficient gradient of r = 0.92 (P = 0.0001). With EUS-RFA a mean of 17.6 ± 10.3 % (range 8.0 % – 53.2 %) of the respective lymph node area was ablated. No complications (i. e. hemodynamic instability, local bleeding, tissue damage) occurred during the procedure. Technical problems included stripping of the probe by the EUS needle and bending of the tip of the probe.

Conclusions: EUS-RFA of lymph nodes was performed safely and successfully using a prototype EUS-compatible probe. This method may have the potential for future use in patient care.

* These authors contributed equally to the work.


 

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