Gastrointest Interv.  2016 Oct;5(3):216-220. 10.18528/gii150025.

Development of a new reagent for endoscopic ultrasound-guided celiac plexus neurolysis and tumor ablation therapy

• Hara K
• Yamao K
• Mizuno N
• Hijioka S
• Imaoka H
• Tajika M
• Tanaka T
• Ishihara M
• Sato T
• Okuno N
• Hieda N
• Yoshida T
• Yasumasa N

• KMID: 2358141
• DOI: http://doi.org/10.18528/gii150025

Abstract

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.

Keyword

Endoscopic ultrasonography; Endoscopic ultrasound-guided celiac plexus neurolysis; Endoscopic ultrasound-guided fine needle aspiration; Endoscopic ultrasound-guided fine needle injection; Interventional endoscopic ultrasound

MeSH Terms

Celiac Plexus*
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endosonography
Ethanol
Indicators and Reagents
Indigo Carmine
Liver
Povidone-Iodine
Swine
Ethanol
Indicators and Reagents
Indigo Carmine
Povidone-Iodine