Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy
PURPOSE Chemical ablation of the gallbladder may be a useful alternative to surgery for inoperable disease. The purpose of this study was to investigate the feasibility of chemical ablation of the gallbladder with acetic acid in a canine model. MATERIALS AND METHODS Five beagle dogs underwent percutaneous transhepatic cholecystostomy. Percutaneous occlusion of the cystic duct was performed with use of n-butyl cyanoacrylate (NBCA) and coils. After confirmation of occlusion of the cystic duct, sclerotherapy of the gallbladder was performed with 4-7 mL of 50% acetic acid through the drainage catheter. Acetic acid was retained for 20 minutes with intermittent position change. The drainage catheter was removed immediately after sclerotherapy. The dogs were euthanized 8 weeks after the procedure. The gallbladders and adjacent organs were evaluated grossly as well as microscopically. RESULTS All dogs survived without serious complications during the experimental period. Sclerotherapy was technically successful in all dogs. Gross specimens of the gallbladder showed shrinkage and fibrotic change without retention of any bile, mucus, or pus. Histologic examinations from the body and fundus of the gallbladder demonstrated complete ablation of the mucosa. However, the neck region of the gallbladder near the cystic duct, where NBCA and coils for cystic duct occlusion were located, had focal areas of remnant or regenerating mucosa. CONCLUSIONS Chemical ablation of the gallbladder with 50% acetic acid was effective and safe. Complete ablation was achieved in the majority of gallbladder mucosa except for a small portion located in the gallbladder neck.