Application of radiofrequency ablation in duodenal mucosal reconstruction

A 63-year-old woman was diagnosed with type 2 diabetes 8 months ago and was scheduled for duodenal mucosal reconstruction. The patient took metformin orally to control blood sugar. Before the operation, fasting blood glucose was 7.0 mmol/L (15.7 mmol/L 2 hours after a meal), and glycosylated hemoglobin was 7.1 %. A single-channel flexible endoscope (EVIS GIF-N170; Olympus, Tokyo, Japan) was introduced into the horizontal part of the duodenum, and the Endoscopic Catheter (Barrx Channel; Medtronic, Minneapolis, USA) was inserted into the biopsy channel of the endoscope ([Fig. 1]). Radiofrequency ablation of the duodenal mucosa was performed, starting from the horizontal part of the duodenum, while the endoscope was gradually withdrawn ([Fig. 2]). By rotating the endoscope and the catheter, all four quadrants of the duodenal mucosa were ablated ([Fig. 3]). Overall, a 13-cm length of duodenal mucosa was ablated without bleeding or perforation ([Fig. 4], [Video 1]).