Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
Department of Biosystems and Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea.
Sci Rep. 2023 May 16;13(1):7917. doi: 10.1038/s41598-023-33635-9.
Nonthermal irreversible electroporation (NTIRE) is emerging as a promising tissue ablation technique. However, maintaining irreversible electroporation (IRE) electrodes against displacement during strong esophageal spasms remains an obstacle. The present study aimed to evaluate the efficacy and safety of newly designed balloon-type endoscopic IRE catheters. Six pigs were randomly allocated to each catheter group, and each pig was subjected to four ablations at alternating voltages of 1500 V and 2000 V. Esophagogastroscopy was performed during the IRE. The ability of balloon-type catheters to execute complete IRE with 40 pulses was assessed. The success rate was higher for the balloon-type catheter than that for the basket-type (12/12 [100%] vs. 2/12 [16.7%], p < 0.001). Following gross inspection and histologic analysis of the 1500-V vs. 2000-V balloon-type catheter revealed a larger mucosal damage area (105.3 mm vs. 140.8 mm, p = 0.004) and greater damage depth (476 μm vs. 900 μm, p = 0.02). Histopathology of the ablated tissue revealed separated epithelium, inflamed lamina propria, congested muscularis mucosa, necrotized submucosa, and disorganized muscularis propria. Balloon-type catheters demonstrated efficacy, achieving full electrical pulse sequences under NTIRE conditions, and a safe histological profile below 2000 V (1274 V/cm). Optimal electrical conditions and electrode arrays pose ongoing challenges.
非热不可逆电穿孔（NTIRE）作为一种有前途的组织消融技术正在兴起。然而，在强烈的食管痉挛期间保持不可逆电穿孔（IRE）电极不发生位移仍然是一个障碍。本研究旨在评估新设计的球囊型内镜 IRE 导管的疗效和安全性。将 6 头猪随机分配到每个导管组，每头猪在 1500V 和 2000V 的交替电压下进行 4 次消融。在 IRE 期间进行食管胃十二指肠镜检查。评估球囊型导管在 40 个脉冲下执行完全 IRE 的能力。球囊型导管的成功率高于篮型（12/12 [100%] 与 2/12 [16.7%]，p<0.001）。在对 1500V 与 2000V 球囊型导管进行大体检查和组织学分析后发现，球囊型导管的粘膜损伤面积较大（105.3mm 与 140.8mm，p=0.004）和损伤深度较大（476μm 与 900μm，p=0.02）。消融组织的组织病理学显示上皮分离、炎症固有层、充血的黏膜肌、坏死的黏膜下层和结构紊乱的固有肌层。球囊型导管在 NTIRE 条件下表现出疗效，可实现全电脉冲序列，在 2000V 以下（1274V/cm）具有安全的组织学特征。最佳的电条件和电极阵列仍存在挑战。
