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. 1990 Aug;31(8):913–917. doi: 10.1136/gut.31.8.913

Clogging of biliary endoprostheses: a new perspective.

P P Coene 1, A K Groen 1, J Cheng 1, M M Out 1, G N Tytgat 1, K Huibregtse 1
PMCID: PMC1378622  PMID: 2387517

Abstract

Endoscopic palliation with biliary endoprostheses is now an established treatment for benign and malignant strictures of the biliary tree. These endoprostheses, however, tend to clog with time. We investigated this problem by undertaking in vitro studies on stents of different designs made of different polymer materials. The stent that performed best was then tested in an in vivo trial. There was a direct relation in vitro between the frictional coefficient of a polymer and the amount of encrusted material. Catheters perfused in bacterially contaminated bile, irrespective of material and design, accrued significantly more sludge than catheters perfused with sterilised bile. The presence of side holes significantly increased the amount of sludge in the stents, but eliminated any differences between the various materials. We therefore investigated the effect of omitting side holes in a clinical trial which consisted of two groups of 20 patients each. The group treated with conventional stents accrued significantly more sludge in the stents than the group treated with experimental stents without side holes (p less than 0.05). The absence of side holes did not cause incomplete drainage or increase morbidity. Side holes are detrimental to stent patency, which is adversely affected by other factors including bacteria and proteins.

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Selected References

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  1. Allain C. C., Poon L. S., Chan C. S., Richmond W., Fu P. C. Enzymatic determination of total serum cholesterol. Clin Chem. 1974 Apr;20(4):470–475. [PubMed] [Google Scholar]
  2. Bradford M. M. A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein-dye binding. Anal Biochem. 1976 May 7;72:248–254. doi: 10.1016/0003-2697(76)90527-3. [DOI] [PubMed] [Google Scholar]
  3. Cotton P. B. Endoscopic methods for relief of malignant obstructive jaundice. World J Surg. 1984 Dec;8(6):854–861. doi: 10.1007/BF01656025. [DOI] [PubMed] [Google Scholar]
  4. Crowther R. S., Wetmore R. F. Fluorometric assay of O-linked glycoproteins by reaction with 2-cyanoacetamide. Anal Biochem. 1987 May 15;163(1):170–174. doi: 10.1016/0003-2697(87)90108-4. [DOI] [PubMed] [Google Scholar]
  5. Groen A. K., Out T., Huibregtse K., Delzenne B., Hoek F. J., Tytgat G. N. Characterization of the content of occluded biliary endoprostheses. Endoscopy. 1987 Mar;19(2):57–59. doi: 10.1055/s-2007-1018235. [DOI] [PubMed] [Google Scholar]
  6. Gurantz D., Laker M. F., Hofmann A. F. Enzymatic measurement of choline-containing phospholipids in bile. J Lipid Res. 1981 Feb;22(2):373–376. [PubMed] [Google Scholar]
  7. Hagenmüller F., Soehendra N. Non-surgical biliary drainage. Clin Gastroenterol. 1983 Jan;12(1):297–316. [PubMed] [Google Scholar]
  8. Ho K. J., Hsu S. C., Chen J. S., Ho L. H. Human biliary beta-glucuronidase: correlation of its activity with deconjugation of bilirubin in the bile. Eur J Clin Invest. 1986 Oct;16(5):361–367. doi: 10.1111/j.1365-2362.1986.tb01010.x. [DOI] [PubMed] [Google Scholar]
  9. Huibregtse K., Katon R. M., Coene P. P., Tytgat G. N. Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc. 1986 Oct;32(5):334–338. doi: 10.1016/s0016-5107(86)71878-6. [DOI] [PubMed] [Google Scholar]
  10. Huibregtse K., Tytgat G. N. Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis. Gut. 1982 May;23(5):371–375. doi: 10.1136/gut.23.5.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. LaRusso N. F., Fowler S. Coordinate secretion of acid hydrolases in rat bile. J Clin Invest. 1979 Oct;64(4):948–954. doi: 10.1172/JCI109561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Leung J. W., Ling T. K., Kung J. L., Vallance-Owen J. The role of bacteria in the blockage of biliary stents. Gastrointest Endosc. 1988 Jan-Feb;34(1):19–22. doi: 10.1016/s0016-5107(88)71223-7. [DOI] [PubMed] [Google Scholar]
  13. Rey J. F., Maupetit P., Greff M. Experimental study of biliary endoprosthesis efficiency. Endoscopy. 1985 Jul;17(4):145–148. doi: 10.1055/s-2007-1018485. [DOI] [PubMed] [Google Scholar]
  14. Siegel J. H., Pullano W., Kodsi B., Cooperman A., Ramsey W. Optimal palliation of malignant bile duct obstruction: experience with endoscopic 12 French prostheses. Endoscopy. 1988 Jul;20(4):137–141. doi: 10.1055/s-2007-1018158. [DOI] [PubMed] [Google Scholar]
  15. Siegel J. H., Snady H. The significance of endoscopically placed prostheses in the management of biliary obstruction due to carcinoma of the pancreas: results of nonoperative decompression in 277 patients. Am J Gastroenterol. 1986 Aug;81(8):634–641. [PubMed] [Google Scholar]
  16. Smit J. M., Out M. M., Groen A. K., Huibregtse K., Jansen P. L., van Marle J., Tytgat G. N. A placebo-controlled study on the efficacy of aspirin and doxycycline in preventing clogging of biliary endoprostheses. Gastrointest Endosc. 1989 Nov-Dec;35(6):485–489. doi: 10.1016/s0016-5107(89)72895-9. [DOI] [PubMed] [Google Scholar]
  17. Speer A. G., Cotton P. B., MacRae K. D. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc. 1988 Sep-Oct;34(5):412–417. doi: 10.1016/s0016-5107(88)71407-8. [DOI] [PubMed] [Google Scholar]
  18. Speer A. G., Cotton P. B., Rode J., Seddon A. M., Neal C. R., Holton J., Costerton J. W. Biliary stent blockage with bacterial biofilm. A light and electron microscopy study. Ann Intern Med. 1988 Apr;108(4):546–553. doi: 10.7326/0003-4819-108-4-546. [DOI] [PubMed] [Google Scholar]
  19. Speer A. G., Cotton P. B., Russell R. C., Mason R. R., Hatfield A. R., Leung J. W., MacRae K. D., Houghton J., Lennon C. A. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987 Jul 11;2(8550):57–62. doi: 10.1016/s0140-6736(87)92733-4. [DOI] [PubMed] [Google Scholar]
  20. Turley S. D., Dietschy J. M. Re-evaluation of the 3 alpha-hydroxysteroid dehydrogenase assay for total bile acids in bile. J Lipid Res. 1978 Sep;19(7):924–928. [PubMed] [Google Scholar]
  21. WEBER A. P., SCHALM L. Quantitative separation and determination of bilirubin and conjugated bilirubin in human serum. Clin Chim Acta. 1962 Nov;7:805–810. doi: 10.1016/0009-8981(62)90063-3. [DOI] [PubMed] [Google Scholar]
  22. Wessel D., Flügge U. I. A method for the quantitative recovery of protein in dilute solution in the presence of detergents and lipids. Anal Biochem. 1984 Apr;138(1):141–143. doi: 10.1016/0003-2697(84)90782-6. [DOI] [PubMed] [Google Scholar]

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