Pressurized Intra-peritoneal Aerosol Chemotherapy (PIPAC) via Endoscopical Microcatheter System

Background/Aim: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is becoming an increasingly widespread approach for delivering intra-peritoneal chemotherapy (IPC) by means of a chemoaerosol. Currently, the aerosol dispersion is achieved by using a special micropump (MIP (R)). However, the delivery of a chemoaerosol into the abdominal cavity is not limited to the MIP (R). This study aimed to investigate the feasibility, drug penetration and distribution of PIPAC via an established endoscopical microcatheter (MC). Materials and Methods: An established ex vivo PIPAC model containing native fresh tissue samples of swine peritoneum was used to aerosolize doxorubicin at a pressure of 12 mm Hg CO2 at 27 degrees degrees Celsius. On the top cover of the PIPAC chamber a MC device was installed via trocar. Tissue specimens were placed as follows: at the bottom of the plastic box (A), at the side wall (B), at the top (C) and the covered bottom (D) of the box. In-tissue doxorubicin penetration was measured using fluorescence microscopy on frozen thin sections. Results: The mean depth of doxorubicin penetration was found to be significantly higher in tissue directly exposed to the aerosol jet. All samples had contact with doxorubicin. Penetration rates were: A: 348 (+/- 47 mu m), B: 174 (+/- 64 mu m), C: 92 (+/-27 mu m) and D: 84 (+/- 45) mu m. Conclusion: Our ex vivo data suggest that PIPAC can be delivered via MC device. While local drug penetration is practically congruent to known PIPAC performance with MIP (R), the MC offers a feasible, flexible, easy to handle and economic improvement compared to conventional PIPAC.