Application of radiofrequency ablation in duodenal mucosal reconstruction

A 63-year-old woman was diagnosed with type 2 diabetes 8 months ago and was scheduled for duodenal mucosal reconstruction. The patient took metformin orally to control blood sugar. Before the operation, fasting blood glucose was 7.0 mmol/L (15.7 mmol/L 2 hours after a meal), and glycosylated hemoglobin was 7.1 %. A single-channel flexible endoscope (EVIS GIF-N170; Olympus, Tokyo, Japan) was introduced into the horizontal part of the duodenum, and the Endoscopic Catheter (Barrx Channel; Medtronic, Minneapolis, USA) was inserted into the biopsy channel of the endoscope ([Fig. 1]). Radiofrequency ablation of the duodenal mucosa was performed, starting from the horizontal part of the duodenum, while the endoscope was gradually withdrawn ([Fig. 2]). By rotating the endoscope and the catheter, all four quadrants of the duodenal mucosa were ablated ([Fig. 3]). Overall, a 13-cm length of duodenal mucosa was ablated without bleeding or perforation ([Fig. 4], [Video 1]).

Fig. 1 The endoscopic catheter was inserted into the biopsy channel of the endoscope.

Fig. 2 Radiofrequency ablation of the duodenal mucosa was performed from the horizontal part of the duodenum.

Fig. 3 By rotating the endoscope and the catheter, all four quadrants of the duodenal mucosa were ablated.

Fig. 4 A 13-cm length of duodenal mucosa was ablated without bleeding or perforation.

Video 1 Application of radiofrequency ablation in duodenal mucosa reconstruction.

The key points of this operation were: 1) the planned radiofrequency ablation sessions targeted the descending and horizontal parts of the duodenum; 2) the power used was 12 J/cm², 48 W; 3) possible adverse events were hemorrhage and perforation; 4) the sedation was general anesthesia (tracheal intubation); 5) the duration of the procedure was 92 minutes.

During the follow-up period of 1 month, the patient stopped taking hypoglycemic drugs, fasting blood glucose decreased to 6.0 mmol/L (11.8 mmol/L 2 hours after a meal), and glycosylated hemoglobin was 6.2 %. The patient did not experience any discomfort.

Duodenal mucosal reconstruction is a catheter-based endoscopic procedure designed to lower blood sugar by altering the surface of the duodenal mucosa [1] [2]. The characteristics of the radiofrequency ablation system are: 1) precise ablation control, which effectively reduces the risk of complications; 2) prediction of treatment effect, which limits damage to normal tissues [3] [4]. We therefore applied this system to the duodenum to achieve a surgical effect similar to that of duodenal mucosal reconstruction.

Endoscopy_UCTN_Code_TTT_1AO_2AN

Competing interests

The authors declare that they have no conflict of interest.

Acknowledgments

The authors would like to thank the China–Japan Friendship Hospital (2018-RC-1) and the Beijing Municipal Commission of Science and Technology (Z151100004015065).

• References

• 1 Hadefi A, Huberty V, Lemmers A. et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes. Digest Dis 2018; 36: 322-324
• 2 Mingrone G, van Baar AC, Devière J. et al. Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: the randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial. Gut 2022; 71: 254-264
• 3 Magee CG, Graham D, Gordon C. et al. Radiofrequency ablation for Barrett’s oesophagus related neoplasia with the 360 Express catheter: initial experience from the United Kingdom and Ireland-preliminary results. Surg Endosc 2022; 36: 598-606
• 4 Yu X, van Munster SN, Zhang Y. et al. Durability of radiofrequency ablation for treatment of esophageal squamous cell neoplasia: 5-year follow-up of a treated cohort in China. Gastrointest Endosc 2019; 89: 736-748

Publication History

Article published online:
21 August 2023