Balloon-assisted laser application for endoscopic treatment of biliary stricture

Seonghee Lim; Van Gia Truong; Seok Jeong; Jiho Lee; Byeong-Il Lee; Hyun Wook Kang

doi:10.1002/lsm.23726

Balloon-assisted laser application for endoscopic treatment of biliary stricture

Lasers Surg Med. 2023 Dec;55(10):912-920. doi: 10.1002/lsm.23726. Epub 2023 Sep 20.

Authors

Seonghee Lim¹, Van Gia Truong², Seok Jeong³, Jiho Lee⁴, Byeong-Il Lee^{1

5}, Hyun Wook Kang^{1

2

4

6}

Affiliations

¹ Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, South Korea.
² Division of Research and Development, TeCure, Inc., Busan, South Korea.
³ Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Inha University Hospital, Incheon, South Korea.
⁴ Division of Smart Healthcare, Major of Biomedical Engineering, College of Information Technology and Convergence, Pukyong National University, Busan, South Korea.
⁵ Division of Smart Healthcare, Major of Human-Bio Convergence, College of Information Technology and Convergence, Pukyong National University, Busan, South Korea.
⁶ Marine-integrated Biomedical Technology Center, Pukyong National University, Busan, South Korea.

PMID: 37727929
DOI: 10.1002/lsm.23726

Abstract

Objectives: Malignant biliary stricture is a ductal narrowing of the bile duct that is often diagnosed at an advanced stage, leading to difficulty in resection. The current study aims to evaluate the feasibility of endobiliary laser treatment by quantifying the extent of coagulative necrosis in tissue under various conditions.

Methods: Ex vivo and in vivo porcine bile tissues were used for endobiliary laser treatment to characterize the dosimetric responses of the tissue to various treatment conditions: power level, irradiation time, and number of treatments. 532 nm laser light was coupled with a balloon-integrated diffusing applicator (BDA) to deliver the laser light endoscopically for tissue coagulation. The coagulated regions (maximum length and depth) in the treated tissues were evaluated histologically for quantitative comparison.

Results: Dosimetric evaluations with ex vivo liver tissue confirmed that both maximum length and depth of coagulative necrosis (CN) increased with applied power and number of treatments. Ex vivo bile duct tests demonstrated that BDA-assisted laser treatment at 10 W for 12 s reproducibly yielded CN with a length of 5.8 ± 1.6 mm and a depth of 0.6 ± 0.2 mm. In vivo tests presented that endoscopic laser treatment using the BDA created CN on the ductal surface without any perforation. Microscopic examinations revealed that a dense inflammatory cell infiltration and eosinophilic area in the in vivo treated tissue. The extent of CN in the in vivo tissue was 40% longer and 120% deeper (length: 8.1 ± 0.7 mm; depth: 1.3 ± 0.2 mm), compared to that in the ex vivo tissue.

Conclusion: BDA-assisted laser treatment could be a feasible option for endoscopic treatment of biliary stricture with uniform ablation at the circumference of bile duct. Further in vivo studies will be performed in a large number of stricture-developed porcine models to examine both efficacy and safety of the proposed endobiliary laser treatment for clinical translations.

Keywords: balloon-integrated diffusing applicator; biliary stricture; common bile duct; endoscopic retrograde cholangiography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Bile Ducts / pathology
Bile Ducts / surgery
Cholestasis* / etiology
Cholestasis* / surgery
Constriction, Pathologic / pathology
Constriction, Pathologic / surgery
Lasers
Necrosis / pathology
Swine