Image-guided stent-directed irreversible electroporation for circumferential ablation in the rat esophagus

Song Hee Kim; Seung Jeong; Jeon Min Kang; Yubeen Park; Dae Sung Ryu; Dong-Sung Won; Ji Won Kim; Chu Hui Zeng; Hyung-Sik Kim; Hong Bae Kim; Sang Soo Lee; Jung-Hoon Park

doi:10.3389/fbioe.2022.934858

Image-guided stent-directed irreversible electroporation for circumferential ablation in the rat esophagus

Front Bioeng Biotechnol. 2022 Nov 17:10:934858. doi: 10.3389/fbioe.2022.934858. eCollection 2022.

Authors

Song Hee Kim^{1

2}, Seung Jeong³, Jeon Min Kang¹, Yubeen Park^{1

2}, Dae Sung Ryu¹, Dong-Sung Won¹, Ji Won Kim^{1

2}, Chu Hui Zeng¹, Hyung-Sik Kim⁴, Hong Bae Kim³, Sang Soo Lee², Jung-Hoon Park¹

Affiliations

¹ Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea.
² Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
³ Department of Biosystems and Biomaterials Science and Engineering, Seoul National University, Seoul, South Korea.
⁴ Department of Mechatronics Engineering, School of ICT Convergence Engineering, College of Science and Technology, Konkuk University, Chungju-si, South Korea.

Abstract

Background: Irreversible electroporation (IRE) has been investigated in the alimentary tract; however, the lack of dedicated electrodes and insufficient tissue responses made its application limited. The aim of this study was to investigate the efficacy and safety of image-guided stent-directed IRE in the rat esophagus. Methods: The bipolar self-expandable electrode (SE) was developed using the braiding technique. A finite element analysis was performed to validate optimal electrical field strength for the rat esophagus. A total of 40 out of 50 rats received stent-directed IRE and were sacrificed at 10 h, 3 days, 7 days, and 28 days of 10 each. The remaining ten rats underwent a sham procedure. The outcomes of stent-directed IRE were assessed by esophagography and histological responses. Results: Stent-directed IRE was technically successful in all rats with mild muscle contraction. The heart rate dropped immediately and gradually recovered at 180 s. TUNEL and caspase-3 with submucosal thickness significantly increased at 10 h and Day 3 compared with those of the sham control (all p < 0.001). The thickness of epithelial layers with collagen deposition significantly decreased at 10 h and Day 3 (all p < 0.001), however, increased at Day 7 compared with that of the sham control (all p < 0.05). The Ki67-positive deposition significantly increased at Day 3 and 7 compared with that of the sham control (all p < 0.001). All variables were similar to those of the sham control at Day 28. Conclusion: Image-guided stent-directed IRE was effective and safe in the rat esophagus. It seems to have effectively and evenly induced cell death and gradually recovered with cellular regeneration.

Keywords: ablation; electrode; esophagus; irreversible electroporation; self-expandable stent.