We showed that sugar augmented radiofrequency ablation (SARFA) applied to the pancreatic perivascular tissue in an ex vivo pancreas swine model showed controlled necrotic ablation due to induced sugar better heat conductivity using specific settings for 300 joules of energy.

Our aim is to show that endoscopic ultrasound SARFA (EUS-SARFA) performed in pancreatic perivascular space in a live swine model using specific RFA settings established in a previous ex-vivo experiment, allows a controlled necrotic ablation without increasing perioperative morbidity and mortality related to pancreatic surgery (duodenopancreatectomy and left pancreatectomy).

EUS-SARFA was performed in the pancreatic parenchyma adjacent to the mesenteric and splenic vessels applying 300 joules of energy using different settings of power (Watts=w) and time (sec=s) in a live swine model.

In group 1 (n=1) and group 2 (n=4), EUS-SARFA was compared with EUS-saline-RFA and EUS-RFA. These groups without survival had tested different settings with same energy. In group 3 (n=3) with survival time of 2, 4 and 7 days (D2, D4 and D7) respectively, used EUS-SARFA was carried-on with prefered settings selected during the previous experiments. Then, surgery was performed starting with duodenopancreatectomy followed 1 hour later by left pancreatectomy. In group 4 (n=1) only surgery was performed.

CT scan 3 acquisitions and 1.5 Tesla magnetic resonance imaging (MRI) were carried-out before and after therapeutic EUS procedures. Each pancreatic specimen was harvested separately at the end of the procedures for histopathological examination.

Surgery was assessed with a pancreatic surgery difficulty score index and compared with the control group 4 (n=1) including duodenopancreatectomy followed by left pancreatectomy.

All procedures were successfully completed. CT-scan and MRI peformed immediately after EUS-SARFA showed normal splenic and mesenteric vessels with a clear hypodense and non-enhancing demarcated area between them and the pancreatic gland due to ischemia of the perforant vessels. Histopathological examination showed largest necrotic ablation volumes with SARFA at 40wx7.5sec and 30wx10sec (300 joules) in non survival specimens when compared with saline-RFA and RFA alone. The survival group surgery at D4 and D7 showed pancreatic local necrosis, adiponecrosis and inflammatory reaction with focal venous thrombosis of small capillaries with more pronounced early fibrosis observed in at D7. Also, surgery at D7 was scored more difficult than surgery at D4 because of incipient fibrosis.

Finally, intraoperative or immediate postoperative complications for EUS-SARFA where non observed, also EUS-SARFA did not increase perioperative morbidity and mortality related to duodenopancreatectomy at D4 and D7 when compared with the control group 4. In the swine with surgery at D2 acute pancreatitis was confirmed after EUS-SARFA and total pancreatectomy was performed due to acute necrotic inflammation.

Pancreatic perivascular EUS-SARFA with specific settings at 300 joules perfomed the same day before pancreatic surgery was an efficient and safe technique enabling a controlled necrotic ablation. This technique could be promising for treatment of pancreatic cancer.