A pilot study of EUS-guided hot saline injection for induction of pancreatic tissue necrosis

Background and study aims: Hot saline may be potentially useful for inducing necrosis of pancreatic tissue. However, the local and systemic effects are largely unknown. This pilot study aimed to evaluate the feasibility and safety of EUS-guided injection of hot saline into the pancreas in the porcine model.

Methods: Boiling hot saline was injected into the tail of normal porcine pancreas under EUS guidance in six pigs via a transgastric approach. Three pigs were killed 4 hours later to study the acute effect of the hot saline injection (acute study). The remaining three pigs were killed after 7 days of clinical observation (survival study).

Result: Injection of 5 mL, 2 mL and 1 mL of hot saline produced localized necrosis (7 – 10 mm) of pancreatic tissue in the acute study. However, there was pooling of hot saline on the surface of the pancreas when 5mL was injected. On the basis of the results of the acute study, the volume of hot saline injected in the survival study was 1 mL. One milliliter of hot saline produced localized or sporadic necrosis of pancreatic tissue without any signs of pancreatitis in all three pigs in the survival study; hot saline was observed to pool on the pancreatic surface of one pig. There was no histological evidence of necrosis in the pancreatic tissue adjacent to the pooled hot saline in either the acute or the survival study.

Conclusion: EUS-guided hot saline injection of pancreatic tissue in the porcine model was technically successful and led to localized necrosis of pancreatic tissue without any sign of pancreatitis.

References

• 1 Jemal A, Siegel R, Ward E. et al . Cancer statistics, 2006.  Cancer J Clin. 2006;  56 106-130
• 2 Warshaw A L, Fernandez-del Castillo C. Pancreatic carcinoma.  N Engl J Med. 1992;  326 455-465
• 3 Geer R J, Brennan M F. Prognostic indicators for survival after resection of pancreatic adenocarcinoma.  Am J Surg. 1993;  165 68-73
• 4 Yeo C J, Cameron J L, Lillemoe K D. et al . Pancreaticoduodenostomy for cancer of the head of the pancreas. 201 patients.  Ann Surg. 1995;  221 447-458
• 5 Sohn T A, Yeo C J, Cameron J L. et al . Resected adenocarcinoma of the pancreas – 616 patients: results, outcomes, and prognostic indicators.  J Gastrointest Surg. 2000;  4 567-579
• 6 Bhutani M S. Endoscopic ultrasound guided antitumor therapy.  Endoscopy. 2003;  35 54-56
• 7 Chang K J, Nguyen P T, Thompson J A. et al . Phase I clinical trial of allogenic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine needle injection in patients with advanced pancreatic carcinoma.  Cancer. 2000;  88 1325-1335
• 8 Aslanian H, Salem R R, Marginean C. et al . EUS-guided ethanol injection of normal porcine pancreas: a pilot study.  Gastrointest Endosc. 2005;  62 723-727
• 9 Matthes K, Mino-Kenudson M, Sahani D V. et al . Concentration-dependent ablation of pancreatic tissue by EUS-guided ethanol injection.  Gastrointest Endosc. 2007;  65 272-277
• 10 Sun S, Wang S, Ge N. et al . Endoscopic ultrasound-guided interstitial chemotherapy in the pancreas: results in a canine model.  Endoscopy. 2007;  39 530-534
• 11 Matthes K, Mino-Kenudson M, Sahani D V. et al . EUS-guided injection of paclitaxel (OncoGel) provides therapeutic drug concentrations in the porcine pancreas.  Gastrointest Endosc. 2007;  65 448-453
• 12 Carrara S, Arcidiacono P G, Albarello L. et al . Endoscopic ultrasound-guided application of a new hybrid cryotherm probe in porcine pancreas: a preliminary study.  Endoscopy. 2008;  40 321-326
• 13 Honda N, Guo Q, Uchida H. et al . Percutaneous hot saline injection therapy for hepatic tumors: an alternative to percutaneous ethanol injection therapy.  Radiology. 1994;  190 53-57
• 14 Araki Y, Hukano M, Urabe M. et al . Hepatocellular carcinoma treated by percutaneous hot saline injection.  Oncol Rep. 2004;  12 569-571
• 15 Kozuch P, Petryk M, Evans A. et al . Therapy for regionally unresectable pancreatic cancer.  Surg Clin North Am. 2001;  81 691-697
• 16 Yusuf T E, Matthes K, Brugge W R. EUS-guided photodynamic therapy with verteporfin for ablation of normal pancreatic tissue: a pilot study in porcine model.  Gastrointest Endosc. 2008;  67 957-961