Mechanisms of Biliary Stent Clogging: Confocal Laser Scanning and Scanning Electron Microscopy

Berkel, A. M. van; Marle, J. van; Groen, A.K.; Bruno, M. J.

doi:10.1055/s-2005-870131

Cited by 111 publications

(67 citation statements)

References 13 publications

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“…Plant fibers from duodenal reflux may also become incorporated into the intraluminal precipitation and further contribute to stent clogging [46]. Microscopic irregularities on the internal surfaces of stents have been shown to enhance precipitation, and attempts have been made to develop coatings which impede colonization by bacteria.…”

Section: Plastic Stentsmentioning

confidence: 99%

Palliation of Malignant Obstructive Jaundice

et al. 2008

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Peri-ampullary and hepatic malignancies will frequently present with obstructive jaundice. For unresectable tumors, effective and lasting decompression of the biliary tree is essential to improve quality of life and survival. An overview of present treatment modalities for palliation of obstructive jaundice is provided, including a systematic review of the English literature regarding the optimum choice of palliation.

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Section: Plastic Stentsmentioning

confidence: 99%

Palliation of Malignant Obstructive Jaundice

et al. 2008

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“…24 Obstruction of plastic stents is mainly attributed to adherence of a bacterial biofilm caused by biliary sludge and duodenobiliary reflux and adherence of dietary fiber to the inner surface of the stent. 25,26 In other words, because many patients with severe jaundice have biliary stasis, biliary sludge is often formed, leading to the high risks of stent obstruction and cholangitis. Our results thus showed that prevention of preoperative cholangitis has an important role in decreasing the incidence of postoperative pancreatic fistula.…”

Section: Discussionmentioning

confidence: 99%

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Kaneko

Inoue

Kida

et al. 2017

Digestive Endoscopy

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Background and Aim: Preoperative cholangitis after preoperative drainage has been reported to increase postoperative complications, particularly pancreatic fistula. We therefore examined the effects of cholangitis after preoperative endoscopic biliary drainage (EBD) on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures. Methods:The study group comprised 102 patients who underwent EBD among patients who underwent surgery. Results:Of the 102 patients, 33 (32%) had postoperative pancreatic fistulas, and 56 (55%) had preoperative cholangitis after preoperative drainage. Analysis of risk factors for preoperative cholangitis showed that a total bilirubin level of 2.9 mg/dL or higher (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.223-7.130; P = 0.016) and a surgical waiting time of 29 days or longer (HR, 4.23; 95% CI, 1.681-10.637; P = 0.02) were independent risk factors for cholangitis. Patients with preoperative cholangitis had a significantly higher incidence of pancreatic fistula than did patients without preoperative cholangitis (78.8 vs 21.2%; P = 0.001). Patients with biliary cancer had a significantly higher incidence of pancreatic fistula than did those with pancreatic cancer (72.7 vs 27.2%; P = 0.005). Multivariate analysis showed that preoperative cholangitis (HR, 4.8; 95% CI,; P = 0.001) and biliary cancer (HR, 3.5; 95% CI, 1.335-8.942; P = 0.006) were significant independent risk factors for postoperative pancreatic fistula.Conclusion: Prevention of preoperative cholangitis, a risk factor for postoperative pancreatic fistula, is likely to decrease the incidence of postoperative pancreatic fistula.

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“…This provokes free reflux of duodenal contents through the stent, which is considered the main cause of stent occlusion [68,69]. Therefore, PSs usually require prophylactic exchange every 2-4 months, particularly in immunocompromised LDLT patients, causing increased cost and patient burden.…”

Section: Inside Stent Placementmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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Mechanisms of Biliary Stent Clogging: Confocal Laser Scanning and Scanning Electron Microscopy

Cited by 111 publications

References 13 publications

Palliation of Malignant Obstructive Jaundice

Palliation of Malignant Obstructive Jaundice

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Endoscopic management of biliary strictures after living donor liver transplantation

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