Minimizing central bile duct injury during radiofrequency ablation: use of intraductal chilled saline perfusion--initial observations from a study in pigs.
OBJECTIVE
To determine whether intraductal perfusion with chilled saline reduces thermal injury to bile ducts during radiofrequency (RF) ablation.


METHODS
In swine, anesthesia was induced and the common bile duct was surgically cannulated with a pediatric feeding tube. RF thermal lesions were created adjacent to bile ducts by using an expandable-hook 2-cm RF electrode and 90-W generator. In three pigs, chilled saline was perfused through the ducts at 1.5 L/h (26 mL/min), and in another pig, room-temperature saline was perfused at the same rate. In three pigs (control group), RF lesions were created without perfusion. After 48 hours, animals were sacrificed. Periductal sections from all animals were reviewed by a liver pathologist. The degree of injury to biliary epithelium and subepithelial glands was assessed on a scale of 0%-100%. Significance of differences between degrees of injury was assessed with the Mann-Whitney test.


RESULTS
In the control group, there was a mean of 100% injury to biliary ductal epithelium and 99.3% to subepithelial ductal glands. In the room-temperature saline group, there was a mean of 100% biliary epithelial injury and 84.4% glandular injury. In the chilled saline group, there was a mean of 52.9% ductal epithelial injury and 12.1% subepithelial glandular injury. In comparison with the control group, there was significantly less (P <.05) thermal injury to biliary epithelium in the chilled saline group and to subepithelial glands in both the room-temperature and chilled saline perfusion groups.


CONCLUSIONS
RF-induced bile duct injury may be decreased significantly with an intraductal infusion of chilled saline.
Raman
Steven S
SS
Department of Radiology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA. sraman@mednet.ucla.edu
Aziz
Donya
D
Chang
Xinlian
X
Ye
Ming
M
Sayre
James
J
Lassman
Charles
C
Lu
David S K
DS
D000818:Animals; D001653:Bile Ducts, Intrahepatic / Q000293:injuries* / Q000473:pathology; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D006358:Hot Temperature / Q000009:adverse effects; D008099:Liver / Q000601:surgery*; D010477:Perfusion; D012965:Sodium Chloride / Q000008:administration & dosage*; D013552:Swine; D013696:Temperature
D012965:Sodium Chloride