title: Perductal electrolytic ablation of the porcine pancreas: a minimally invasive option-studies of morbidity and mortality.
abstract: BACKGROUND
  Pancreatic cancer has a dismal prognosis. Few patients are suitable for surgical resection, leaving the majority requiring symptom palliation. Current palliative techniques such as surgical bypass and endoscopic retrograde cholangiopancreatography (ERCP) are imperfect. A novel palliative therapy combining the symptom control of surgical bypass with the minimally invasive nature of ERCP is required.
  
  
  METHODS
  Perductal electrolytic ablation of pancreatic tissue, in a porcine model, was performed. There were two survival groups of 2 weeks (n = 4) and 8 weeks (n = 4). Postoperatively, serum biochemistry, amylase and C-reactive protein (CRP) were assessed. Histological examination of the pancreas, lungs, and kidneys was performed to determine the presence of acute pancreatitis or systemic inflammatory response.
  
  
  RESULTS
  An immediate transient increase in both amylase and CRP was seen. Although pancreatic histology demonstrated localised necrosis at the electrolytic site at 2 weeks, there was no evidence of generalized pancreatitis or a systemic inflammatory response at either 2 or 8 weeks.
  
  
  CONCLUSIONS
  This study suggests that, although there is localized pancreatic necrosis and transient hyperamylasemia, perductal pancreatic electrolytic ablation is safe, with neither generalized pancreatitis nor a systemic inflammatory response, in the medium and long term. Although performed in normal porcine pancreas, because of the absence of a large-animal model of pancreatic cancer, this study suggests that electrolytic pancreatic ablation is safe. This technique may have a role in the palliation of pancreatic cancer, especially if delivered via a minimally, invasive approach, and warrants further investigation.
authors.affiliation: University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia.
authors.forename: C P
authors.initials: CP
authors.lastname: Morrison
authors.forename: F G
authors.initials: FG
authors.lastname: Court
authors.forename: S A
authors.initials: SA
authors.lastname: Wemyss-Holden
authors.forename: B D
authors.initials: BD
authors.lastname: Teague
authors.forename: A
authors.initials: A
authors.lastname: Burrell
authors.forename: M
authors.initials: M
authors.lastname: Texler
authors.forename: M S
authors.initials: MS
authors.lastname: Metcalfe
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
authors.forename: G J
authors.initials: GJ
authors.lastname: Maddern
mesh_terms: D000818:Animals; D004572:Electrolysis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D010166:Palliative Care; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods*; D013552:Swine; D013997:Time Factors