Endoscopic high-intensity focused US: technical aspects and studies in an in vivo porcine model (with video)
2015
Background High-intensity focused US (HIFU) is becoming more widely used for noninvasive and minimally invasive ablation of benign and malignant tumors. Recent studies suggest that HIFU can also enhance
targeted drug deliveryand stimulate an antitumor immune response in many tumors. However, targeting pancreatic and
liver tumorsby using an extracorporeal source is challenging due to the lack of an adequate acoustic window. The development of an EUS-guided HIFU transducer has many potential benefits including improved targeting, decreased energy requirements, and decreased potential for injury to intervening structures. Objective To design, develop, and test an EUS-guided HIFU transducer for endoscopic applications. Design A preclinical, pilot characterization and
feasibility study. Setting Academic research center. Patients Studies were performed in an in
vivoporcine model. Intervention Thermal ablation of in
vivoporcine pancreas and liver was performed with EUS-guided focused US through the gastric tract. Results The transducer successfully created lesions in gel phantoms and ex
vivobovine livers. In
vivostudies demonstrated that targeting and creating lesions in the porcine pancreas and liver are feasible. Limitations This was a preclinical, single-center
feasibility studywith a limited number of subjects. Conclusion An EUS-guided HIFU transducer was successfully designed and developed with dimensions that are appropriate for endoscopic use. The feasibility of performing EUS-guided HIFU ablation in
vivowas demonstrated in an in
vivoporcine model. Further development of this technology will allow endoscopists to perform precise therapeutic ablation of periluminal lesions without breaching the wall of the gastric tract.
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