Prevention of biliary lesions that may occur during radiofrequency ablation of the liver: study on the pig.
OBJECTIVE
To prevent bile duct injury by using a cold 5% glucose isotonic solution cooling in the bile ducts when radiofrequency (RF) is performed in a porcine model.


BACKGROUND
Complications that may arise during liver RF ablation include biliary stenosis and abscesses.


METHODS
The RITA 1500 generator was used for the experiments. Two lesions were performed in the left liver. The pigs were killed 1 or 3 weeks after the procedure. An ex vivo cholangiogram was obtained by direct injection into the main bile duct. Samples of RF lesions, of liver parenchyma near and at a distance from the RF lesions, underwent pathologic studies. Two groups of 20 pigs each were treated: one without perfusion of the bile ducts and the other with perfusion of cold 5% glucose isotonic solution into the bile ducts. The Pringle maneuver was used in 50% of the RF procedures. Radiologic lesions were classified as biliary stenosis, complete interruption of the bile duct, or extravasation of the radiologic contrast liquid.


RESULTS
Histologic lesions of the bile ducts were observed near the ablated RF lesion site and at a distance from the RF lesions when a Pringle maneuver was performed. Radiologic and histologic lesions of the bile ducts were significantly reduced (P < 0.0001) when the bile ducts were cooled.


CONCLUSIONS
Cooling of the bile ducts with a cold 5% glucose isotonic solution significantly protects the intrahepatic bile ducts from damages caused by the heat generated by RF when performed close to the bile ducts.
Marchal
Frédéric
F
Department of Surgery, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France. f.marchal@nancy.fnclcc.fr
Elias
Dominique
D
Rauch
Philippe
P
Zarnegar
Rasa
R
Leroux
Agnès
A
Stines
Joseph
J
Verhaeghe
Jean-Luc
JL
Guillemin
François
F
Carteaux
Jean Pierre
JP
Villemot
Jean Pierre
JP
D000007:Abdominal Injuries / Q000209:etiology / Q000517:prevention & control*; D000818:Animals; D001652:Bile Ducts / Q000293:injuries*; D017115:Catheter Ablation / Q000009:adverse effects*; D005947:Glucose / Q000008:administration & dosage*; D007036:Hypothermia, Induced / Q000379:methods; D007552:Isotonic Solutions / Q000008:administration & dosage*; D023421:Models, Animal; D010477:Perfusion; D013552:Swine
D007552:Isotonic Solutions; D005947:Glucose