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First published online February 18, 2008
British Journal of Radiology (2008) 81, 413-421
© 2008 British Institute of Radiology
doi: 10.1259/bjr/25340112
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Full paper

The effects of 188rhenium-filled balloon dilation following bare stent placement in a rabbit oesophageal model

J H SHIN, MD1, S K LEE, MD2, H-YO SONG, MD1, J-S KIM, MD3, H CHOE, PHD4, E-H KIM, PhD5, I J LEE, MD6, T-H KIM, MS1, E-Y KIM, MS1, C-W WOO, BS1 and K HOON NAH, MS4

Departments of 1 Radiology and Research Institute of Radiology, 2 Internal Medicine, 3 Pathology and 4 Physiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, 5 Department of Nuclear Engineering, Seoul National University, Seoul, 6 Department of Radiology, Hallym University Sacred Heart Hospital, 896 Pyungchon-dong, Dongan-gu, Anyang-city, Gyeonggi-do, 431-070, Korea

Correspondence: Professor Ji Hoon Shin, University of Ulsan College of Medicine, Department of Radiology, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. E-mail: jhshin{at}amc.seoul.kr

The objective of the study was to evaluate the efficacy of β-radiation using a rhenium-188-mercaptoacetyltriglycine (188Re-MAG3)-filled balloon for preventing tissue hyperplasia secondary to bare stent placement in a rabbit oesophageal model. Immediately following bare stent placement in 30 rabbits, 10 underwent conventional contrast-filled balloon dilation (control group, Group I), and 20 underwent 188Re-MAG3-filled balloon dilation, with half of these receiving 20 Gy (Group II) and half receiving 40 Gy (Group III) at a 1 mm tissue depth. Diameter percentage stenosis was calculated using oesophagography performed before sacrifice 6 weeks later. Gross and microscopic findings were obtained at both an area of untreated oesophageal tissue and a mid-stent area. Apoptosis and an apoptotic index in the mid-stent area were evaluated in two rabbits from each group. 13 rabbits survived the scheduled 6-week stent placement. Diameter percentage stenosis for Groups II and III was significantly lower than for Group I. The oesophageal mucosa showed nodularity in Group I and smoothness in Groups II and III. Oesophageal mucosal erythema (n = 9) and perforations (n = 10) were observed in Groups II and III only. Mid-stent epithelial layer thickness and muscularis propria destruction differed between the three groups (p<0.05). Apoptosis was increased and the apoptotic index was higher in Groups II and III than in Group I. In conclusion, 188Re-MAG3-filled balloon dilation was effective in preventing tissue hyperplasia secondary to bare stent placement, but at the cost of an increased risk of radiation-induced mucosal inflammation and perforation, in a rabbit oesophageal model. Apoptosis may be the mechanism underlying this irradiation-induced suppression of tissue hyperplasia.






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