Clogging of biliary endoprostheses: a new perspective.

Protein Adsorption and Bacterial Adhesion to Biliary Stent Materials

“…The suggested a role of bacteria and characteristics of stent bile was used within 1 month after sampling. materials in clogging formation [3][4][6][7][8]. Studies on Perfusion model.…”

Cost-Effectiveness Decision Analyses Comparing Covered to Uncovered Self-Expandable Metal Stents to Elective or on Demand Polyethylene Stent Changes in Patients with Distal Malignant Biliary Obstruction

“…First, bile from post-operative patients was removed from T -tubes, pooled and run in a closed circuit that contained the stent. The 'in vitro' analysis revealed that presence of side holes significantly increased the amount of sludge irrespective of the type of plastic material used [33]. This fmding was subsequently tested in 40 patients with distal biliary malignant obstruction.…”

“…The protein found in the obstructed stent is of unknown origin but it has been postulated to arise from bacterial products, given that stents perfused with sterile bile seem to not accumulate sludge [31]. Defects in the manufacturing of plastic biliary stents such as irregular inner surface and badly constructed side holes have been hypothesized to facilitate bacterial colonization and consequently may accelerate the time to occlusion [32,33]. Bacteria are usually not present in the biliary tract of healthy individuals owing to their clearance by the constant flow of bile (800 -1000 milliliters per day), and the presence ofanatomical barriers (the sphincter of Oddi, and mucus produced by the biliary mucosa).…”

“…However, in vitro studies suggested that si de holes can also accelerate sludge formation presumably because of turbulence of the bile flow stream generated by its rough surface orifice [33]. Coene and colleagues performed an 'in vitro' and a pilot clinical study with plastic stents of different designs and materials.…”

“…PE stents with and without side holes were inserted in a total of 40 patients and removed for analysis after 2 months. Although aIl stents were patent on eye examination at removal, a quantitative sludge analysis demonstrated that stents without side holes had a significant lower amount of sludge that was distributed along the entire inner surface; in contrast, sludge accumulation was greatest at the rims of the side holes [31,33]. A series of studies comparing plastic stents with and without side holes have been done, most of which have compared PE and Teflon Tannenbaum (TT) stents.…”