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KMID : 1048120160050030216
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International Journal of Gastrointestinal Intervention
2016 Volume.5 No. 3 p.216 ~ p.220
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Development of a new reagent for endoscopic ultrasound-guided celiac plexus neurolysis and tumor ablation therapy
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Hara Kazuo
Yamao Kenji
Mizuno Nobumasa
Hijioka Susumu
Imaoka Hiroshi
Tajika Masahiro
Tanaka Tutomu
Ishihara Makoto
Sato Takamitu
Okuno Nozomi
Hieda Nobuhiro
Yoshida Tukasa
Niwa Yasumasa
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Abstract
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Background: Both endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) and tumor ablation using ethanol are very common procedures, and the utility of these therapies has already been reported in prominent journals. However, their effectiveness appears temporary and insufficient, especially EUS-CPN. We therefore have to consider new reagents for improving the results. The present study examined the best concentration of ethanol and povidone iodine mixed with atelocollagen for more effective therapies.
Methods: The effects of the new reagents were confirmed in three live pigs. At first, we injected three kinds of reagents (including indigo carmine) in three separate areas of para-aortic tissue under EUS guidance in one pig. At more than 4 hours after injection, we checked ethanol injection sites after dissection. In next study, we performed EUS-guided injection of a total of six kinds of reagents (two kinds of ethanol, three kinds of povidone iodine, and control atelocollagen) into the livers of two living pigs. After 2 weeks, we examined tissue damage to the liver in the two pigs.
Results: The 75% ethanol (absolute ethanol 3.75 mL + 1% atelocollagen 1.25 mL + a very small amount of indigo carmine) was seen like blue gel, and still remained in the para-aortic tissue. Brownish areas of povidone iodine mixed with 3% atelocollagen exhibited clear, regular borders with greatly reduced infiltration into surrounding tissue compared to others.
Conclusion: We concluded that 75% ethanol mixed with 1% atelocollagen appears optimal for EUS-CPN. Povidone iodine mixed with 3% atelocollagen may be suitable for small tumor ablation therapy.
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KEYWORD
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Endoscopic ultrasonography, Endoscopic ultrasound-guided celiac plexus neurolysis, Endoscopic ultrasound-guided fine needle aspiration, Endoscopic ultrasound-guided fine needle injection, Interventional endoscopic ultrasound
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