Application of a silver coating on plastic biliary stents to prevent biofilm formation: an experimental study using electron microscopy

Yamabe, Akane; Irisawa, Atsushi; Wada, Ikuo; Shibukawa, Goro; Fujisawa, Mariko; Sato, Ai; Igarashi, Ryo; Maki, Takumi; Hoshi, Koki

doi:10.1055/s-0042-115173

Cited by 12 publications

(5 citation statements)

References 35 publications

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“…In this study, a significantly lower inflammatory response was observed in the group with silver-coated stent than in the group without silver-coated stent, and electron microscopy clearly revealed that fewer bacteria adhered to the stent surface. We have also reported the effectiveness of silver ion-coated PS in a theoretical study [38], and similar to the study by Wen et al, we found minimal bacterial adhesion on the surface of silver ion-coated stents, with only several cells found and no meshwork or biofilm formation observed. Wen et al conducted an examination in a short period of 1 or 7 days after stent placement; however, we performed our culture after the stent was soaked in infected bile over a long period, i.e., 4 weeks, and even after such a long period, no bacterial adhesion as noted on the surface of the silver-coated stent, which suggested that stent patency could be achieved over a long period.…”

Section: Medical Devices Utilizing Silver Ionssupporting

confidence: 89%

Development of biliary stent applying the antibacterial activity of silver: A literature review

Yamabe

Irisawa

Kunogi

et al. 2021

BME

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BACKGROUND: Endoscopic transpapillary stenting is commonly performed in patients with obstructive jaundice caused by a biliary stricture. Although the plastic stent (PS) is widely used for biliary drainage because of the low-cost and easy procedure, patency is short after placement in the bile duct because of the small diameter. Dysfunction of PS is primarily caused by biliary sludge that forms as a result of bacterial adhesion and subsequent biofilm formation on the inner surface of the stent. It is well known that silver ions have excellent antibacterial activity against a wide range of microorganisms. OBJECTIVE: This review provides an overview and perspective of the significance of silver-coated biliary stents. METHODS: We collected literature regarding silver-coated biliary stents, and reviewed the current research/development status and discussed their possible usefulness. RESULTS: To date, several in vivo/vitro studies evaluated the patency of silver-blended or silver-coated biliary stents. These studies suggested that the silver coating on a PS was likely to prolong the patency period. CONCLUSION: The development of biliary stents using silver is expected to prolong stent patency and prevent frequent stent replacement.

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Section: Medical Devices Utilizing Silver Ionssupporting

confidence: 89%

Development of biliary stent applying the antibacterial activity of silver: A literature review

Yamabe

Irisawa

Kunogi

et al. 2021

BME

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“…Several studies have shown the effects of antibiotic coatings on medical devices effective against biofilm formation; however, such data has not been as successfully replicated for biliary stents[ 27 ]. Recently some workers have found that biliary plastic stents coated with silver nano particles or ions have antibacterial activity against several organisms and extends the period of use of biliary stents[ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Characterization of biofilms in biliary stents and potential factors involved in occlusion

Vaishnavi¹,

Samanta²,

Kochhar³

2018

WJG

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AIMTo quantify the components in biofilms and analyze the predisposing factors involved in occlusion of biliary stents.METHODSIn a prospective study conducted from April 2011 to March 2014 at a tertiary care hospital, all consecutive patients who required endoscopic biliary stent exchange/removal were included. Etiology of the biliary disease was diagnosed by imaging, cytology and on follow-up. Clinical details of patients with biliary stent retrieval were noted. All extracted stents were collected in sterile containers and immediately processed for quantification of biofilm proteins and polysaccharides. Molecular identification of commonly known and unknown bacteria was performed by polymerase chain reaction and density gradient gel electrophoresis methods.RESULTSEighty one patients (41 males) with age range of 20-86 years were studied. The underlying causes for stent insertion were bile duct stones (n = 46; 56.8%) benign stricture (n = 29; 35.8%) and malignancy (n = 6; 7.4%) with cholangitis in 50 (61.7%) patients. The retrieved stent sizes were 7 Fr (n = 62; 76.5%) and 10 Fr (n = 19; 23.5%) with 65 days median insertion duration. Polybacterial consortia were detected in 90.1% of the stents. The most common bacteria identified by polymerase chain reaction alone and/or sequencing were Pseudomonas (n = 38), Citrobacter (n = 23), Klebsiella (n = 22), Staphylococcus (n = 20), Serratia (n = 16), Escherichia coli (n = 14), Streptococcus (n = 13), Enterococcus (n = 13), Aeromonas (n = 12), Proteus (n = 10) and Enterobacter (n = 9). Protein concentration according to gender (0.547 ± 0.242 mg/mL vs 0.458 ± 0.259 mg/mL; P = 0.115) as well as age > 60 years and < 60 years (0.468 ± 0.295 mg/mL vs 0.386 ± 0.238 mg/mL; P = 0.205) was non-significant. However, polysaccharide concentration was significant both according to gender (0.052 ± 0.021 mg/mL vs 0.049 ± 0.016 mg/mL; P < 0.0001) and age (0.051 ± 0.026 mg/mL vs 0.038 ± 0.016 mg/mL; P < 0.011). Protein concentration in the biofilm was significantly higher (0.555 ± 0.225 mg/mL vs 0.419 ± 0.276 mg/mL; P = 0.018) in patients with cholangitis, lower (0.356 ± 0.252 mg/mL vs 0.541 ± 0.238 mg/mL; P = 0.005) in the 10 Fr group than the 7 Fr group, and significantly higher (0.609 ± 0.240 mg/mL vs 0.476 ± 0.251 mg/mL; P = 0.060) in stents of ≥ 6 mo of indwelling time. However presence/absence of cholangitis, size of stent, indication of stent insertion and indwelling time did not affect the quantity of polysaccharide concentration.CONCLUSIONPlastic stents retrieved from patients with biliary tract disease showed polymicrobial organisms with higher protein content among patients with cholangitis and those with smaller diameter stents. Longer indwelling duration had more biofilm formation.

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“…Apart from optimizing diagnosis and treatment of the infection itself, the data indicate a potential to optimize stents for deployment in areas of infection, e.g., by using antimicrobial coatings. Similar approaches are currently under development for stent therapy in the biliary tract [ 33 , 34 ]. Whether such an approach can be translated into the treatment of pancreatic necrosis, however, needs to be investigated in further experimental studies.…”

Section: Discussionmentioning

confidence: 99%

Infection of (Peri-)Pancreatic Necrosis Is Associated with Increased Rates of Adverse Events during Endoscopic Drainage: A Retrospective Study

Frost

Schlesinger

Wiese

et al. 2022

JCM

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Pancreatic necroses are a major challenge in the treatment of patients with pancreatitis, causing high morbidity. When indicated, these lesions are usually drained endoscopically using plastic or metal stents. However, data on factors associated with the occurrence of failure or adverse events during stent therapy are scarce. We retrospectively analyzed all adverse events and their associated features which occurred in patients who underwent a first-time endoscopic drainage of pancreatic necrosis from 2009 to 2019. During the observation period, a total of 89 eligible cases were identified. Adverse events occurred in 58.4% of the cases, of which 76.9% were minor (e.g., stent dislocation, residual lesions, or stent obstruction). However, these events triggered repeated interventions (63.5% vs. 0%, p < 0.001) and prolonged hospital stays (21.0 [11.8–63.0] vs. 14.0 [7.0–31.0], p = 0.003) compared to controls without any adverse event. Important factors associated with the occurrence of adverse events during endoscopic drainage therapy were positive necrosis cultures (6.1 [2.3–16.1], OR [95% CI], p < 0.001) and a larger diameter of the treated lesion (1.3 [1.1–1.5], p < 0.001). Superinfection of pancreatic necrosis is the most significant factor increasing the likelihood of adverse events during endoscopic drainage. Therefore, control of infection is crucial for successful drainage therapy, and future studies need to consider superinfection of pancreatic necrosis as a possible confounding factor when comparing different therapeutic modalities.

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Application of a silver coating on plastic biliary stents to prevent biofilm formation: an experimental study using electron microscopy

Cited by 12 publications

References 35 publications

Development of biliary stent applying the antibacterial activity of silver: A literature review

Development of biliary stent applying the antibacterial activity of silver: A literature review

Characterization of biofilms in biliary stents and potential factors involved in occlusion

Infection of (Peri-)Pancreatic Necrosis Is Associated with Increased Rates of Adverse Events during Endoscopic Drainage: A Retrospective Study

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