title: High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system-current state of the art and future perspectives.
abstract: BACKGROUND
  High intensity focused ultrasound (HIFU) is emerging as a valid minimally-invasive image-guided treatment of malignancies. We aimed to review to current state of the art of HIFU therapy applied to the digestive system and discuss some promising avenues of the technology.
  
  
  METHODS
  Pertinent studies were identified through PubMed and Embase search engines using the following keywords, combined in different ways: HIFU, esophagus, stomach, liver, pancreas, gallbladder, colon, rectum, and cancer. Experimental proof of the concept of endoluminal HIFU mucosa/submucosa ablation using a custom-made transducer has been obtained in vivo in the porcine model.
  
  
  RESULTS
  Forty-four studies reported on the clinical use of HIFU to treat liver lesions, while 19 series were found on HIFU treatment of pancreatic cancers and four studies included patients suffering from both liver and pancreatic cancers, reporting on a total of 1,682 and 823 cases for liver and pancreas, respectively. Only very limited comparative prospective studies have been reported.
  
  
  CONCLUSIONS
  Digestive system clinical applications of HIFU are limited to pancreatic and liver cancer. It is safe and well tolerated. The exact place in the hepatocellular carcinoma (HCC) management algorithm remains to be defined. HIFU seems to add clear survival advantages over trans arterial chemo embolization (TACE) alone and similar results when compared to radio frequency (RF). For pancreatic cancer, HIFU achieves consistent cancer-related pain relief. Further research is warranted to improve targeting accuracy and efficacy monitoring. Furthermore, additional work is required to transfer this technology on appealing treatments such as endoscopic HIFU-based therapies.
authors: IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France;; IHU-Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France;
authors: Michele
authors: M
authors: Diana
authors: IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France ;
authors: Luigi
authors: L
authors: Schiraldi
authors: IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France;; Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan;
authors: Yu-Yin
authors: YY
authors: Liu
authors: IHU-Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France;; Department of Digestive Surgery, University Hospital of Strasbourg, France.
authors: Riccardo
authors: R
authors: Memeo
authors: IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France;; Department of Digestive Surgery, University Hospital of Strasbourg, France.
authors: Didier
authors: D
authors: Mutter
authors: IHU-Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France;; Department of Digestive Surgery, University Hospital of Strasbourg, France.
authors: Patrick
authors: P
authors: Pessaux
authors: IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France;; IHU-Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France;
authors: Jacques
authors: J
authors: Marescaux
keywords: High intensity focused ultrasound (HIFU); endoluminal applications of HIFU; liver cancer; miniature HIFU delivery system; mucosa and submucosal ablations using HIFU; pancreatic cancer