Basic Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2017; 23(12): 2141-2148
Published online Mar 28, 2017. doi: 10.3748/wjg.v23.i12.2141
Effect of a poloxamer 407-based thermosensitive gel on minimization of thermal injury to diaphragm during microwave ablation of the liver
Li-Li Zhang, Gui-Min Xia, Yu-Jiang Liu, Rui Dou, John Eisenbrey, Ji-Bin Liu, Xiao-Wei Wang, Lin-Xue Qian
Li-Li Zhang, Yu-Jiang Liu, Rui Dou, Lin-Xue Qian, Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Gui-Min Xia, Xiao-Wei Wang, Department of Pharmaceutics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100054, China
John Eisenbrey, Ji-Bin Liu, Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, United States
Author contributions: Xia GM and Qian LX contributed equally to this work; Zhang LL, Xia GM, Qian LX designed the research, analyzed the data, wrote and revised the paper; Zhang LL, Liu YJ, Dou R and Wang XW performed the research; Eisenbrey J and Liu JB revised the paper; all the authors approved the final draft for submission.
Supported by the Clinical-Basic Cooperation Program from Capital Medical University, No. 15JL10; the National Key Research and Development Program, No. 2016YFA0201504; and the Beijing Training Project For The Leading Talents in S & T, No. Z14110700154002.
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of the Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University (IACUC No. 15-4003).
Conflict-of-interest statement: The authors alone are responsible for the paper. The authors declare no conflicts of interest.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at qianlinxue2002@163.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Lin-Xue Qian, Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Yong’an Road 95, Beijing 100050, China. qianlinxue2002@163.com
Telephone: +86-10-63138576 Fax: +86-10-83165944
Received: December 12, 2016
Peer-review started: December 13, 2016
First decision: January 10, 2017
Revised: January 21, 2017
Accepted: February 16, 2017
Article in press: February 17, 2017
Published online: March 28, 2017
Processing time: 105 Days and 11.5 Hours
Abstract
AIM

To assess the insulating effect of a poloxamer 407 (P407)-based gel during microwave ablation of liver adjacent to the diaphragm.

METHODS

We prepared serial dilutions of P407, and 22.5% (w/w) concentration was identified as suitable for ablation procedures. Subsequently, microwave ablations were performed on the livers of 24 rabbits (gel, saline, control groups, n = 8 in each). The P407 solution and 0.9% normal saline were injected into the potential space between the diaphragm and liver in experimental groups. No barriers were applied to the controls. After microwave ablations, the frequency, size and degree of thermal injury were compared histologically among the three groups. Subsequently, another 8 rabbits were injected with the P407 solution and microwave ablation was performed. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN) and creatinine (Cr) in serum were tested at 1 d before microwave ablation and 3 and 7 d after operation.

RESULTS

In vivo ablation thermal injury to the adjacent diaphragm was evaluated in the control, saline and 22.5% P407 gel groups (P = 0.001-0.040). However, there was no significant difference in the volume of ablation zone among the three groups (P > 0.05). Moreover, there were no statistical differences among the preoperative and postoperative gel groups according to the levels of

ALT, AST, BUN and Cr in serum (all P > 0.05).

CONCLUSION

Twenty-two point five percent P407 gel could be a more effective choice during microwave ablation of hepatic tumors adjacent to the diaphragm. Further studies for clinical translation are warranted.

Keywords: Microwave ablation; Injury; Hepatocellular carcinoma; Poloxamer; Hydrodissection

Core tip: Collateral thermal damage is the most common complication of microwave ablation. Conventional liquids can move away and be absorbed quickly, proving difficult to get a good separation effect. This study aimed to assess the insulating effect of a poloxamer 407 (P407)-based thermosensitive gel during microwave ablation of the liver adjacent to the diaphragm. We prepared serial dilutions of P407, and 22.5% (w/w) concentration was identified as suitable for ablation procedures. The 22.5% P407 effectively protected the diaphragm during microwave ablation of the liver, and was superior to 5% dextrose in water and 0.9% saline.