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Review
. 2016 Aug;5(4):329-44.
doi: 10.21037/hbsn.2015.11.03.

High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system-current state of the art and future perspectives

Affiliations
Review

High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system-current state of the art and future perspectives

Michele Diana et al. Hepatobiliary Surg Nutr. 2016 Aug.

Abstract

Background: High intensity focused ultrasound (HIFU) is emerging as a valid minimally-invasive image-guided treatment of malignancies. We aimed to review to current state of the art of HIFU therapy applied to the digestive system and discuss some promising avenues of the technology.

Methods: Pertinent studies were identified through PubMed and Embase search engines using the following keywords, combined in different ways: HIFU, esophagus, stomach, liver, pancreas, gallbladder, colon, rectum, and cancer. Experimental proof of the concept of endoluminal HIFU mucosa/submucosa ablation using a custom-made transducer has been obtained in vivo in the porcine model.

Results: Forty-four studies reported on the clinical use of HIFU to treat liver lesions, while 19 series were found on HIFU treatment of pancreatic cancers and four studies included patients suffering from both liver and pancreatic cancers, reporting on a total of 1,682 and 823 cases for liver and pancreas, respectively. Only very limited comparative prospective studies have been reported.

Conclusions: Digestive system clinical applications of HIFU are limited to pancreatic and liver cancer. It is safe and well tolerated. The exact place in the hepatocellular carcinoma (HCC) management algorithm remains to be defined. HIFU seems to add clear survival advantages over trans arterial chemo embolization (TACE) alone and similar results when compared to radio frequency (RF). For pancreatic cancer, HIFU achieves consistent cancer-related pain relief. Further research is warranted to improve targeting accuracy and efficacy monitoring. Furthermore, additional work is required to transfer this technology on appealing treatments such as endoscopic HIFU-based therapies.

Keywords: High intensity focused ultrasound (HIFU); endoluminal applications of HIFU; liver cancer; miniature HIFU delivery system; mucosa and submucosal ablations using HIFU; pancreatic cancer.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA flowchart. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Prediction of cranio-caudal displacement of the liver during breathing. (A) 3D reconstruction of the liver in non-forced expiration; (B) same case, reconstruction in non-forced inspiration; (C) a structured light beam is projected on the abdominal wall to track movements of the abdominal wall during respiration; (D) 3D model of the liver showing the cranio-caudal displacement during respiratory cycle; (E) the virtual clone of the patient, including biomechanical modeling of the liver’s elastic properties, is projected onto the patient’s skin and registered using fixed points (anterior superior iliac spine): in this Augmented Reality image the patient is in non-forced expiration; (F) same as E, but in non-forced inspiration: note the predicted displacement of the liver by the biomechanical modeling.
Figure 3
Figure 3
Endoscopic HIFU to ablate GI mucosa. (A) Endoscopic view of the miniature HIFU transducer during application on the gastric mucosa, after a submucosal protective air-cushion has been obtained to block HIFU delivery beyond the submucosa layer; (B) effect of a 30 W 10 s sonication (300 J); (C) effect of a 30 W 20 s sonication (600 J); (D) histology aspect of the mucosa, showing ablated mucosa and submucosa on the application site (10×). HIFU, high intensity focused ultrasound.
Figure 4
Figure 4
Confocal imaging of the burned area. (A) Endoscopic view of confocal endomicroscopy probe scanning porcine sigmoid mucosa before HIFU application; (B) confocal probe scanning of the ablated mucosa; (C) microscopic confocal image of sigmoid before HIFU: note the regular shape of enterocytes; (D) same spot after burning: note the loss of imaging of mucosa with some phantom images of round enterocytes. HIFU, high intensity focused ultrasound.

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