Endoscopic ultrasound-guided pancreatic cavitation: Proof-of- Concept in a vascularized human cadaveric model

Background: Pancreatic ductal adenocarcinoma's poor prognosis is due in part to its desmoplastic tumor microenvironment (TME), which hinders the bioavailability of anti-tumor drugs. Selectively targeting the physical properties of TME by ultrasonic cavitation could make systemic therapies more effective. We have designed an endoscopic ultrasound prototype capable to reach pancreatic parenchyma. The aim of this study was to demonstrate the feasibility of inducing cavitation in the pancreas with this prototype.Materials and methods: We prepared 5 cadaveric models: 3 non-perfused, and 2 perfused with the Sim-Life technology based on revascularization of human cadaver with a blood avatar. This technology allowed microbubbles to be injected to enhance cavitation. The device was positioned into the stomach via transesophageal approachResults: These tests confirmed that transesophageal navigation of the prototype into the stomach was feasible in the human cadaveric model. This not only enabled targeting pancreatic parenchyma, but also to successfully create ultrasonic cavitation in the pancreatic gland by delivering ultrasound combined with microbubbles.Conclusion: Our work establishes a proof-of-concept for the generation of cavitation in the pancreas of a perfused human cadaveric model using an echoendoscope, and paves the way for preliminary clinical work with a prospect of Endosonographic delivery of cavitation to pancreatic cancer.