Department of Hepatobiliary Surgery and National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, China.
School of Energy and Power Engineering, Xi'an Jiaotong University, No.28, West Xianning Road, Xi'an, 710049, China.
Surg Endosc. 2021 Oct;35(10):5665-5674. doi: 10.1007/s00464-020-08245-5. Epub 2021 Jan 8.
The aim of this study was to evaluate the feasibility, safety, and efficacy of magnetic anchoring and guidance-assisted endoscopic irreversible electroporation (MAG-IRE) for gastric mucosal ablation.
A catheter-based, donut-like, and MAG-assisted electrode was developed. MAG-IRE for gastric mucosal ablation was performed in eight beagle canines. The parameters of one set of IRE was 500 V voltage, 100 μs pulse duration, and 99 pulses. The MAG time, operation time, success rate, and adverse events were measured. Endoscopic examination was performed from 30 min to 28 days post-IRE. Full-thickness gastric tissue was harvested by wedge biopsy for histopathological analysis.
30 (93.75%) of the 32 lesions were successfully ablated by MAG-IRE. The median MAG time was 300 s (IQR 120-422.5 s), and the median operation time was 491.5 s (IQR 358.3-632.5 s). No adverse events occurred. Ulceration was observed, starting from 3 days post-IRE. The mucosa healed 14 to 28 days post-IRE. Hematoxylin-Eosin (H&E) staining showed inflammatory infiltration, edema, and congestion in the ablated mucosa. Masson's Trichrome staining showed that the gastric wall and blood vessels in the ablation area were intact. TUNEL assay showed diffuse positive cells in ablated mucosa as early as 30 min post-IRE.
MAG-IRE for gastric mucosal ablation is feasible, safe, and effective. It can be a potential therapeutic option for minimally invasive treatment of gastric neoplasm.
本研究旨在评估磁锚定和引导辅助内镜不可逆电穿孔（MAG-IRE）用于胃黏膜消融的可行性、安全性和疗效。
研制了一种基于导管的、甜甜圈样的、具有 MAG 辅助的电极。对 8 只比格犬进行了胃黏膜消融 MAG-IRE。一组 IRE 参数为 500V 电压、100μs 脉冲持续时间和 99 个脉冲。测量 MAG 时间、手术时间、成功率和不良事件。IRE 后 30min 至 28 天进行内镜检查。通过楔形活检采集全层胃组织进行组织病理学分析。
32 个病灶中的 30 个（93.75%）通过 MAG-IRE 成功消融。MAG 时间中位数为 300s（IQR 120-422.5s），手术时间中位数为 491.5s（IQR 358.3-632.5s）。无不良事件发生。IRE 后 3 天开始出现溃疡。IRE 后 14 至 28 天黏膜愈合。苏木精-伊红（H&E）染色显示消融黏膜有炎症浸润、水肿和充血。Masson 三色染色显示消融区域的胃壁和血管完整。TUNEL 检测显示 IRE 后 30min 即可见消融黏膜内弥漫性阳性细胞。
胃黏膜消融 MAG-IRE 是可行、安全和有效的。它可能成为胃肿瘤微创治疗的一种潜在治疗选择。
