Endoscopic Ultrasound-Guided Procedure Could Transform Blood Pressure Management

By HospiMedica International staff writers
Posted on 13 Feb 2025

Image: Molecular imaging of the adrenal glands in three patients (Photo courtesy of QMUL)

Primary aldosteronism (PA) is a hormonal disorder that causes high blood pressure in approximately one in 20 patients with hypertension but often goes undiagnosed and untreated. In this condition, benign nodules in the adrenal glands produce excessive aldosterone, a hormone that elevates blood pressure by increasing salt levels in the body. Patients with PA often do not respond to standard blood pressure medications, putting them at higher risk for heart attacks, strokes, and kidney failure. Until recently, the only effective treatment for PA was the surgical removal of the affected adrenal gland. However, this procedure requires general anesthesia, a hospital stay, and weeks of recovery, leading many patients to remain untreated. Now, researchers have introduced a groundbreaking, minimally invasive treatment called Triple T, which offers new hope for millions of people suffering from high blood pressure caused by PA. This treatment, which could revolutionize the management of blood pressure, was published in The Lancet.

Triple T, or endoscopic ultrasound-guided radiofrequency ablation, has shown remarkable potential in clinical trials and could serve as a viable alternative to surgery. This innovative treatment targets and destroys malfunctioning adrenal nodules without removing the adrenal gland, offering a faster, safer, and less invasive solution. The procedure utilizes a combination of radiofrequency or microwaves and ultrasound to deliver precise heat to the adrenal nodule. A fine needle is inserted through the stomach, guided by real-time ultrasound imaging, to reach the adrenal gland, where short bursts of heat are applied to destroy the problematic tissue. This technique minimizes damage to surrounding healthy tissues, ensuring a targeted approach. The entire procedure takes just 20 minutes and requires no incisions.

Triple T’s effectiveness is due in part to advancements in diagnostic imaging, which now use molecular dyes to precisely locate even the smallest adrenal nodules. These innovations, coupled with the ability to directly target nodules near the stomach, have enabled this minimally invasive approach. In the feasibility study known as the Feasibility study of radiofrequency endoscopic ABlation, with ULtrasound guidance (FABULAS) trial, a team of doctors, including researchers from Queen Mary University of London (QMUL, London, UK), tested Triple T on 28 PA patients and achieved excellent results. The procedure was both safe and effective, with most patients experiencing normalized hormone levels within six months. Many were able to discontinue all blood pressure medications, and the condition did not return. The success of the FABULAS trial has led to the initiation of a larger study, WAVE, which will compare Triple T to traditional surgery in 120 patients, with results expected in 2027.

“This less invasive technique could be widely offered in endoscopy units across the UK and internationally,” said Professor Stephen Pereira, Chief Investigator of FABULAS, emphasizing the potential global impact of Triple T.