The Treatment of a Benign Biliary Stricture with a Novel, Endoscopically Inserted Biodegradable Biliary Stent

Autor: Joonas Mikkonen, Juhani Sand, Johanna Laukkarinen, Heidi Gröhn, Isto Nordback
Rok vydání: 2005
Předmět:
Zdroj: Gastrointestinal Endoscopy. 61:AB97
ISSN: 0016-5107
DOI: 10.1016/s0016-5107(05)00646-2
Popis: The Treatment of a Benign Biliary Stricture with a Novel, Endoscopically Inserted Biodegradable Biliary Stent Johanna Laukkarinen, Juhani Sand, Joonas Mikkonen, Heidi Grohn, Isto Nordback Introduction and Aim: Treatment of benign bile duct strictures (BDS) is a challenging clinical problem. Despite the development of various mini-invasive BDS treatment methods, such as percutaneous or endoscopic stenting techniques, the results are far from satisfactory. Drawback of the nonsurgical treatment of the BDS is the need for multiple approaches. An ideal method might be stenting of the stricture with enlarging, self absorbing stent either endoscopically or percutaneously under fluoroscopy. Our aim was to study a one-approach technique with a new, biodegradable biliary stent (BDBS) inserted duodenoscopically in treating the BDS in a large animal model. Methods: Yorkshire pigs with ischemic BDS (n Z 24; model reported in Gastroenterolology 2004;126(suppl2):A-775) either underwent duodenoscopy and ERC (n Z 16), where the braided, selfenlarging BaSO4–PLA BDBS (Group 1; n Z 8) or metallic Wallstent (Group 2; nZ 8) was inserted into the site of the BDS, or had no approach (Group 3; nZ 8), and were followed by repeated 99mTecnetium biligraphy, x-ray and serum determinations until death or sacrificed at 6 months, when the BDS was measured. Results: After confirming the BDS in fluoroscopy, BDBS (Group 1) or metallic stent (Group 2) was successfully inserted in 7/8 animals in both Group 1 and 2. The Group 1 and 2 pigs did not differ in serum liver function tests or in liver clearance 45 min after 99mTc injection during the follow-up time. In the x-ray the stent was seen in all of the Group 2 animals still at 6 months, but in none of the Group 1 animals after 3 months. At 6 months the BD lumen was open in Groups 1 and 2; BDBS had dissolved in all of the Group 1 animals, whereas in Group 2 animals the metallic stent was still in situ. All Group 3 (BDS) animals died for biliary cirrhosis before 6 months. Conclusions: This novel biodegradable biliary stent ensures biliary drainage and seems promising when a benign bile duct stricture is stented endoscopically. 503 Duodeno-Biliary Reflux May Contribute to Biliary Stent Occlusion: Prospective Randomized Study of a New Biliary Stent with An Anti-Duodeno-Biliary Reflux Valve in Patients with Biliary Strictures Kulwinder S. Dua, Jasmohan S. Bajaj, Nageshwar Reddy, G. Rao Introduction: The mechanism leading to occlusion of plastic biliary stents is not known. Duodeno-biliary reflux may be a contributory factor as plant material has been found in some of these occluded stents (Zhang et al, Gastroenterol 2003). In a recent study, an anti-reflux valve was attached to a plastic biliary stent and using in vitro techniques, this anti-reflux biliary stent was shown to be effective in preventing retrograde flow without interfering with the primary function of the stent, namely, antegrade flow (Dua et al Gastrointest Endosc 2001). Aims: To evaluate the impact of preventing duodeno-biliary reflux on biliary stent occlusion. Methods: Tannenbaum (10Fr, no side-holes, Wilson-Cook Medical) stents were modified by attaching a 4.5 cm tubular Teflon sheath to their duodenal ends to work like a ‘‘windsock’’ valve (AR-biliary stent). Twenty patients with common bile duct strictures (pancreas cancer 10, cholangiocarcinoma 8, benign strictures 2) were randomized to either a standard 10Fr. Tannenbaum stent or an AR-biliary stent. Age, sex, disease characteristics and length of stents used were similar between the two groups. To prevent reflux around the stent, sphincterotomy was not performed in any patient. All patients were followed up and stent occlusion was determined by clinical monitoring, liver functions and stent evaluation after removal. Results: There were no technical difficulties in placing the AR-biliary stent using techniques similar to standard Tannenbaum stents. Mean duration of patency for the AR-biliary stents was 163 G 13SD days compared to 113 G 10 days for the standard stents (p Z 0.005). There was no stent migration in either group and both stents were equally effective in improving liver function tests. Conclusion: Anti-reflux biliary stents remain patent for a longer time compared to standard stents. This finding suggests that duodeno-biliary reflux may contribute towards stent occlusion.
Databáze: OpenAIRE
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