Plastic Biliary Stent Occlusion: Factors Involved and Possible Preventive Approaches

Donelli, Gianfranco; Guaglianone, Emilio; Rosa, Roberta; Fiocca, Fausto; Basoli, A

doi:10.3121/cmr.2007.683

Cited by 144 publications

(120 citation statements)

References 81 publications

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“…However, patients who had several stents implanted simultaneously (in SZ) had less bacterial heterogeneity across multiple stents than patients who had several stents implanted consecutively (BS). This increased similarity in bacterial compositions between stent biofilms from patients with simultaneously introduced stents seems reasonable because those stents are assumed to be concurrently inoculated by an ascending infection of the duodenal microbiota (Sung, 1995;Liu et al, 1996;Donelli et al, 2007). As the duodenal bacterial composition and thus the possibly contaminating bacterial community is supposed to be subject to major changes over time because of rapid peristalsis and the short transit time of the lumenal contents (Wilson, 2005), this may explain the higher heterogeneity in communities of stents that have been implanted consecutively.…”

Section: Discussionmentioning

confidence: 99%

“…However, cultivation methods are labour-intensive and only limited numbers of stents can be intensively analyzed at any given time. In addition, inconsistencies in species compositions between recent studies (Donelli et al, 2007) are most likely because of differences in the cultivation media and the techniques used rather than the true differences in diversity among the different stents.…”

Section: Introductionmentioning

confidence: 94%

“…However, the positioning of biliary stents results in the disruption of the sphincter of Oddi and microbial contamination through an ascending infection by duodenal biliary reflux (Sung et al, 1992). The major limitation of stent therapy is stent occlusion by a microbial biofilm (Donelli et al, 2007;Nocker et al, 2007), in which the stent lifetime decreases with repeated replacement, being possibly because of earlier microbial contamination of a usually sterile biliary system (Matsuda et al, 1991). There has been some effort to identify the microbial species responsible for stent colonization using culture-dependent approaches (Donelli et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

“…The major limitation of stent therapy is stent occlusion by a microbial biofilm (Donelli et al, 2007;Nocker et al, 2007), in which the stent lifetime decreases with repeated replacement, being possibly because of earlier microbial contamination of a usually sterile biliary system (Matsuda et al, 1991). There has been some effort to identify the microbial species responsible for stent colonization using culture-dependent approaches (Donelli et al, 2007). From work to date, it is thought that these biofilms are predominantly composed of facultative anaerobic Gram-positive Enterococcus sp.…”

Section: Introductionmentioning

confidence: 99%

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Characterization of the complex bacterial communities colonizing biliary stents reveals a host-dependent diversity

et al. 2009

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This study provides a comprehensive survey of the spatial and temporal bacterial composition of biliary stent biofilms. The bacterial diversity, distribution and dynamics of 59 biliary and 4 pancreatic stent communities from 40 patients being treated at two different hospitals, which implant stents either simultaneously or consecutively, were characterized by single-strand conformation polymorphism (SSCP) analysis. Fifty-one phylotypes belonging to 5 bacterial phyla and 24 bacterial families were detected across 63 stents. This is a much broader diversity than previously detected through culture-dependent methods, particularly in regard to the diversity of obligate anaerobes. Stent bacterial diversity was patient-dependent and more similar when stents were implanted simultaneously rather than consecutively. Stent bacterial community composition differed between hospitals specifically because of the difference in abundance of Bifidobacteria. Co-colonization of Veillonella sp., Streptococcus anginosus and organisms closely related to Fusobacterium nucleatum revealed a potentially important attachment and survival strategy that has yet to be reported in biliary stents. This work reveals a more complete survey of the identities of bacterial species that form biofilms in biliary stents, their co-colonization patterns and the natural variation in species composition between different patients, hospitals and locations along the stent. Consideration of the community composition from individual patients will allow tailoring of prophylactic antibiotic treatments and thus will make the management of stent biofilms more effective.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characterization of the complex bacterial communities colonizing biliary stents reveals a host-dependent diversity

et al. 2009

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“…However, the major limitation of this approach is represented by stent occlusion followed by life-threatening cholangitis, often requiring stent removal and replacement with a new one (2). Although it is generally believed that microbial colonization of the inner surface of the stent plays an important role in initiating the clogging process, so far available data are not sufficient for a full understanding of this phenomenon (3,4).…”

Section: Introductionmentioning

confidence: 98%