Novel endoscopic laser treatment of common bile duct stenosis using balloon catheter-integrated diffusing applicator (BCDA)

초록

Endoscopic biliary drainage including stent are a well-accepted clinical method for treating common bile duct (CBD) stenosis, but the treatment is only successful in the short term with stent exchange at 3 to 6 months. The current study aims to demonstrate a novel endoscopic retrograde cholangiopancreatography (ECRP)-guided laser ablation technique on CBD stenosis by using a balloon catheter-integrated diffusing applicator (BCDA) for uniform treatment of tubular tissue. A 532 nm laser system was employed with BCDA to thermally coagulate the CBD tissue. For performance assessments, photothermal and mechanical responses of the tissue were evaluated in both ex vivo and in vivo mini-pig models in terms of structural and histological variations after the laser treatment. The ex vivo results confirmed the irreversible thermal denaturation in liver tissue without carbonization. The in vivo mini-pig tests confirmed high durability of BCDA during the ERCP procedures and no evidence of CBD perforation. Histological analysis validated a thin circumferential coagulation in the CBD with no or minimal injury to the peripheral organs. The proposed BCDAassisted treatment may be a feasible endoscopic ablation method for treating disease or disorder in a tubular tissue structure. Further in vivo studies will investigate CBD stenosis-developed animal models to evaluate the chronic response of the laser-treated CBD tissue as well as the recurrence of CBD stenosis.

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