We found that a bipolar RF catheter provided varying degrees of mucosal ablation. Although the biliary mucosa response was similar to that seen with esophageal RF ablation, we found that RF ablation could result in transmural injury at high powers. Furthermore, we found that wattage was the most important determinant of the depth of ablation and

not voltage. In solid organs, we found that the ablation provided by the VX-809 in vitro bipolar catheter was tissue specific. Minimal tissue necrosis was achieved in the liver, whereas excellent tissue responses were seen in the pancreas. The purpose of defining the solid-organ tissue response was not to establish a clinical purpose of catheter RF ablation but instead to determine the capabilities of catheter ablation in malignant tissue, perhaps simulating the presence of a malignant bile duct mass. There are several parameters that might determine the tissue responsiveness to RF ablation, including the presence of local blood vessels that could act to dissipate the heat from the RF catheter.4 and 11 The study was limited by the use of a normal animal model. Furthermore, the RF catheter was not placed endoscopically. Future Epigenetics Compound Library research buy studies might examine the response

to RF ablation in excised human bile duct malignancy. RF energy applied to the bile duct or solid organs resulted in controlled ablation, with a linear relationship between the depth of ablation in the bile duct and RF power. “
“A 70-year-old man was admitted with acute dysphagia to solids and liquids. He had a history of gastroesophageal reflux disease, Barrett’s esophagus, and large hiatal hernia, and he had previously undergone three antireflux surgical procedures, including a Nissen fundoplication, and then two repeated operations, the first through a left thoracoabdominal approach and the second through a right thoracotomy. His most recent endoscopy, performed for surveillance of Barrett’s

esophagus 2 months before admission, showed long segment Barrett’s esophagus, a hiatal hernia with patent hiatal narrowing (A) and large gastric wrap folds around the cardia on retroflexed view (B). Upon admission, an esophagogram revealed distal esophageal obstruction. Upper endoscopy showed Ribonucleotide reductase a mildly dilated esophagus and intussusception of gastric folds within the hernia sac (C). The adjacent mucosa appeared edematous and mottled (D), and the hiatal narrowing was tight. This was traversed with the endoscope, moderate resistance being encountered, and the intussusception was successfully reduced. A nasogastric tube was placed, and the patient was referred to thoracic surgery. Intraoperatively, a posterior fundoplication of 270 degrees was identified; the wrap and distal esophagus were found to have herniated into the chest. The wrap was taken down, followed by placement of a mesh posteriorly to reinforce the repair. The patient had an uneventful recovery. All authors disclosed no financial relationships relevant to this publication.