The effect on porcine bile duct of a metallic stent covered with a paclitaxel-incorporated membrane

Savard

Journal of Surgical Research

et al. 2007

Background-The cellular and molecular mechanisms of fibrogenesis in the extrahepatic biliary epithelium are not known. TGF-β1 is a cytokine implicated in signaling pathways that mediate collagen formation. An observation that paclitaxel (PT), applied topically into the rat common bile duct, inhibited stricture formation led us to hypothesize that PT's effects might be due to interruption of TGF-β1 signaling between biliary epithelial cells and subepithelial myofibroblasts.

Section: Discussionmentioning

confidence: 98%

Paclitaxel Interrupts TGF-β1 Signaling Between Gallbladder Epithelial Cells and Myofibroblasts

Savard

Journal of Surgical Research

et al. 2007

Archivos de Bronconeumología (English Edition)

“…The correct drug dosage is also important in order to avoid tissue damage 31 . In another study, high paclitaxel concentration was associated with a worse response in the biliary duct 32 . The biliary duct and tracheal wall both have different histological structures compared to vessels, where the use of DES has been most effective.…”

Section: Discussionmentioning

confidence: 91%

Tracheal Self-Expandable Metallic Stents: A Comparative Study of Three Different Stents in a Rabbit Model

Serrano

Lostalé

Rodríguez-Panadero

et al. 2016

“…Kalinoswki et al [10] demonstrated that incubation with paclitaxel inhibited proliferation of human gallbladder cells, human fibroblasts, and pancreatic cells in a dose-dependent fashion. In a porcine model, SEMS coated with a paclitaxel-incorporated membrane were not associated with transmural necrosis or perforation [11]. Paclitaxel-eluting stents also appear to be safe in a canine model [12].…”

mentioning

confidence: 87%

Drug-Eluting Stents in Malignant Biliary Obstruction: Where Do We Stand?

Shah

2012

Dig Dis Sci

In patients with malignant biliary obstruction, endoscopic placement of biliary stents offers similar technical success rates but a lower risk of complications and a trend towards decreased mortality when compared to surgical bypass and percutaneous drainage [1,2]. As a result, over the last three decades, endoscopic retrograde cholangiography (ERC)-guided stent placement has become the preferred approach to palliate malignant biliary obstruction.Until the 1990s, only plastic stents were available. Plastic stents may occlude within 3-6 months, often requiring repeated ERC procedures in order to exchange the stents. The introduction of a stainless-steel uncovered metal stent (Wallstent, Boston Scientific) heralded a major advance in extending the duration of stent patency. Although self-expandable metallic stents (SEMS) are more expensive than plastic stents, they are cost-effective when compared to plastic stents for patients expected to live longer than 3 months due to the need for fewer subsequent ERC procedures [1,[3][4][5][6]. Nonetheless, SEMS do eventually occlude in 19-40 % of patients [3][4][5]. The duration of SEMS patency has remained largely unchanged in spite of modifications in stent composition and the addition of a plastic coating [7][8][9]. Thus, a clear need exists for technologic improvements that minimize stent occlusion.The major mechanisms of SEMS occlusion are tumor ingrowth, tumor overgrowth, and epithelial hyperplasia. These mechanisms provide the rationale for developing a stent that is coated with or locally elutes a chemotherapeutic agent in order to improve stent patency. In vitro and animal studies suggest that a paclitaxel-coated stent may be safe and potentially efficacious when used for malignant biliary obstruction. Kalinoswki et al. [10] demonstrated that incubation with paclitaxel inhibited proliferation of human gallbladder cells, human fibroblasts, and pancreatic cells in a dose-dependent fashion. In a porcine model, SEMS coated with a paclitaxel-incorporated membrane were not associated with transmural necrosis or perforation [11]. Paclitaxel-eluting stents also appear to be safe in a canine model [12].Limited data exist regarding outcomes of paclitaxeleluting stents for malignant biliary obstruction in humans. In a pilot study of 21 humans with malignant biliary obstruction, SEMS coated with a paclitaxel-incorporated membrane remained patent for a mean of 429 days (cumulative patency rate at 3, 6, and 12 months of 100, 71, and 36 %, respectively) [13]. The pilot study suggests a paclitaxel-coated SEMS may provide longer patency rates than the 10-12 months provided by standard uncovered or covered SEMS and informed the author's decision to proceed with a larger prospective study [1].The current study by the same investigators is a prospective comparison of standard covered SEMS to SEMS covered by a paclitaxel-incorporated membrane [14]. Stents were 5-8 cm in length and 10 mm in diameter in both groups. The authors initially planned the study as a randomized controlled trial...