What Is Endoscopic Ablation?

Endoscopic ablation is a procedure in which a surgeon passes a viewing scope and treatment instruments through small incisions into the body and uses electric current, freezing gases or heat to destroy, detach and coagulate abnormal tissue or tumors. Complications from ablation include the possibility of explosion or fire during the procedure, scar tissue formation, and unintentional tissue perforation.

Multipolar electrocautery, also known as MPEC, is one type of ablation that surgeons use to remove tissue. The surgeon passes a catheter through an endoscopic tube and into the body. The end of the catheter has two small electrodes which introduce the current and make a completed circuit. The surgeon also has the capability of injecting irrigating fluids into the site. By making direct contact and applying light pressure, a controlled amount of current passes into the tissue which burns, cuts and controls bleeding simultaneously.

Argon plasma coagulation, commonly referred to as APC, is another minimally invasive surgery that applies current to tissue. It does not, however, require direct contact. During this endoscopic ablation procedure, surgeons pass a flexible catheter through the endoscope into the body. The tip has a tungsten electrode which receives an electrical current. Depressing a foot pedal releases argon gas which arcs when coming in contact with the current. The arc alone contacts tissue and the depth of destruction relies on the amount of gas flowing through the catheter.

Radiofrequency endoscopic ablation uses minute multiple, specially-spaced electrodes to introduce electrically-produced heat to abnormal tissue. Using a guide wire, surgeons insert a catheter alongside the endoscope. Physicians use irrigation fluids to prevent tissue adhesion and to clear the surgical field. When performing the procedure on the esophageal region, surgeons may insert a balloon which when inflated beyond the tissue site keeps the area open and accessible. The procedure typically causes superficial cellular destruction.

The cryotherapy method of endoscopic ablation uses liquid nitrogen or some other refrigerant for tissue destruction. Surgeons insert a cold tip catheter alongside the endoscopic instrument. Usually triggered by pedal control, physicians spray the freezing substance through the catheter and onto tissue. After approximately 10 to 15 seconds of spraying the substance, the tissue turns white. The cells thaw in 10 to 30 seconds and rupture from expansion secondary to freezing.

After endoscopic ablation, patients may experience adverse effects from anesthesia. Postoperative patients generally experience pain and discomfort from direct tissue trauma and from tissue expansion because of the gas used to inflate body cavities. Abscesses and infections may develop at the infection site, usually indicated by a fever. Vascular blood clots might also occur, causing a potential risk for heart attack, pulmonary embolism, and strokes.