• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
      • SAGES Robotics Residents and Fellows Courses
      • MIS Fellows Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / High Intensity Focused Ultrasound (HIFU) for Submucosal Gastrointestinal Tissue Ablation. Proof of the Concept in the Porcine Model.

High Intensity Focused Ultrasound (HIFU) for Submucosal Gastrointestinal Tissue Ablation. Proof of the Concept in the Porcine Model.

Michele Diana, MD1, Bernard Dallemagne, MD2, Yu-Yin Liu, MD2, Veronique Lindner, MD, PhD3, Jacques Marescaux, MD, FACS, HonFRCS, HonFJSES, HonAPSA2. 1Institute for Image-Guided Surgery (IHU-Strasbourg), 2Research Institute against Cancer of the Digestive System (IRCAD), 3Pathology Department, University Hospital of Strasbourg, France

Objective of the technology or device

Advanced minimally invasive surgical endoscopic techniques, such as endoscopic submucosal dissection (ESD), are more and more frequently used in the management of early-stage gastrointestinal cancers. However, ESDs are challenging and time-consuming. The possibility to expand the indications of endoscopic heat-based ablative techniques, mainly used to treat dysplastic and/or premalignant tissues, to early-stage gastrointestinal malignancies could have a great clinical impact. This paradigm shift would require: the ability to deliver a tunable energy, with predictable results and a low risk of injuries to adjacent structures, and the possibility to monitor the efficacy of the treatment in real-time and obtain staging information. The aim of this experimental acute study was to evaluate a concept of submucosal ablation based on a fine-tuned emission of High-Intensity Focused Ultrasounds (HIFU) in direct contact with the mucosa.

Description of the technology and method of its use or application

The active part of the contact HIFU device is a 7MHz flat piezoceramic transducer, measuring 8 by 15mm. The transducer is mounted on the tip of a flexible endoscope. To lift the submucosa and protect the deeper layers (muscular and serosa) from the action of HIFU, a bolus of air (10cc) is injected into the submucosal space, before the application of the HIFU. The presence of an air interface, which reflects ultrasounds, creates an effective and long-lasting lifting of the submucosa/mucosa complex. The effects of the sonications can be evaluated in real-time with a probe-based confocal endomicroscopic system.

Preliminary results

A total of 19 sonications have been performed in the stomach (n=7) and in the colon (n=12) of one anesthetized pig. Based on previous ex vivo and in vivo dose-response tests, the device was set to deliver an average of 500J for stomach sonications and 350J for colon sonications during 20 seconds to create an effective heat destruction on the submucosal layer. Mean depth of HICU lesions was 3±1.07mm and 1±0.6mm in the stomach and in the colon respectively. The most frequent histological signs of the sonications were architecture distortion, coagulation necrosis, congestion and edema. Those lesions were limited to the mucosa and submucosa. No damage to the muscular and serosal layers was noted, except in two colonic sonications, in which air cushion, due to technical error, was not properly created and full-thickness lesions were observed. Confocal imaging could identify specific clues for early mucosa coagulation damage such as deformation or disappearance of enterocytes’ borders. Comparable images were obtained at Hematoxylin-Eosin stained biopsies.

Conclusions/future directions

This contact HIFU device could create in vivo targeted lesions at submucosal level. The submucosal air cushion generates a reflective barrier to the HIFUs, avoiding any further progression down to the muscular and serosal layers and preventing energy transmission to adjacent organs. Confocal imaging can be useful for real-time monitoring of ablation efficacy, at least at mucosal level. A needle-based confocal probe could provide information on the deep aspect of the submucosa. The prototype is undergoing further refinements and dose-effects studies prior to evaluation in survival studies.

104

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon

Related



Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals