Moll, XavierFondevila, DolorsGarcía Arnas, FélixPérez, Juan J.Ielpo, BenedettoSánchez Velázquez, Patricia, 1985-Grande Posa, LuísJaume, SofíaRadosevic, Aleksandar, 1974-Barranco Priego, Luis EugenioBerjano, Enrique J.Burdío Pinilla, FernandoAndaluz, Anna2024-03-072024-03-072023Moll X, Fondevila D, García-Arnas F, Pérez JJ, Ielpo B, Sánchez-Velázquez P, Grande L, Jaume S, Radosevic A, Barranco L, Berjano E, Burdio F, Andaluz A. Is occlusion of the main pancreatic duct by thermal ablation really safe? A surgical innovation assessed according to IDEAL recommendations. Int J Hyperthermia. 2023;40(1):2203888. DOI: 10.1080/02656736.2023.22038880265-6736http://hdl.handle.net/10230/59342Introduction: Pre-clinical studies suggest that thermal ablation of the main pancreatic duct (TAMPD) is more recommendable than glue for reducing postoperative pancreatic fistula (POPF). Our aims were (1) to analyze the changes in the pancreas of patients after TAMPD and (2) to correlate the clinical findings with those obtained from a study on an animal model. Materials and methods: A retrospective early feasibility study of a marketed device for a novel clinical application was carried out on a small number of subjects (n = 8) in whom TAMPD was conducted to manage the pancreatic stump after a pancreatectoduodenectomy (PD). Morphological changes in the remaining pancreas were assessed by computed tomography for 365 days after TAMPD. Results: All the patients showed either Grade A or B POPF, which generally resolved within the first 30 days. The duct's maximum diameter significantly increased after TAMPD from 1.5 ± 0.8 mm to 8.6 ± 2.9 mm after 7 days (p = .025) and was then reduced to 2.6 ± 0.8 mm after 365 days PO (p < .0001). The animal model suggests that TAMPD induces dilation of the duct lumen by enzymatic digestion of ablated tissue after a few days and complete exocrine atrophy after a few weeks. Conclusions: TAMPD leads to long-term exocrine pancreatic atrophy by completely occluding the duct. However, the ductal dilatation that occurred soon after TAMPD could even favor POPF, which suggests that TAMPD should be conducted several weeks before PD, ideally by digestive endoscopy.application/pdfeng© 2023 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1080/02656736.2023.2203888Duct occlusionIDEAL recommendationsPancreatic ductPostoperative pancreatic fistulaThermal ablationinfo:eu-repo/semantics/openAccess