The possibilities of endoluminal ablation techniques



Year of publication 2015
Type Appeared in Conference without Proceedings
MU Faculty or unit

Faculty of Medicine

Description Tumours growing from the epithelium of the biliary tract are most common in the hilar region and the complexity of the perihilar liver region causes curative surgical resection to be very complicated. The resectability and the 5-year survival rate of hilar cholangiocarcinomas are very low. There are many tested chemotherapeutic regimes combining systemic delivery with intra-arterial chemotherapy or chemoembolization, but none of these has yet become the standard therapy. In addition to palliative surgical procedures, endoscopic and percutaneous therapeutic methods of the bile ducts drainage there are several competing techniques and interventions aiming to control of disease - radiation therapies (external beam, intraluminal brachytherapy), photodynamic therapies and endoluminal ablations. More often they are so-called tailored oncological therapies. Local ablation techniques such as endoluminal radiofrequency ablation with simple and one-time application are potentially useful in debulking of the endoluminal tumours, preventing early ingrowth of the tumours through the stent mesh, and even helping to resolve stent obstruction. Another alternative therapeutic intervention in this field is non-thermal ablation method - irreversible electroporation. During electroporation the cells in the tissue are exposed to the short pulses of very high voltages. Pulses of high voltage changes transmembrane electrochemical potential resulting in cell membrane instabilities and disruption of the membrane. The advantage of electroporation to the radiofrequency ablation is the absence of heat damage to healthy tissue, the precise shape and volume of necrosis and this technique also lacks of the heat sink effect. The architecture of the tissue is preserved and reparation along it is possible. Hilar cholangiocarcinoma is a complex medical problem. Survival times can be influenced by optimal drainage, brachytherapy, photodynamic therapy or other ablation treatments.
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