Faculty Collaboration Database

Impact of reducing duodenobiliary reflux on biliary stent patency: an in vitro evaluation and a prospective randomized clinical trial that used a biliary stent with an antireflux valve. Gastrointest Endosc 2007 May;65(6):819-28

Date

03/27/2007

Pubmed ID

17383650

DOI

10.1016/j.gie.2006.09.011

Scopus ID

2-s2.0-34247281671 (requires institutional sign-in at Scopus site)   87 Citations

Abstract

BACKGROUND: The mechanisms leading to occlusion of plastic biliary stents (PBS) are not known.

OBJECTIVE: To evaluate the impact of reducing duodenobiliary reflux on stent patency rate.

DESIGN: A newly designed antireflux PBS (AR-PBS) was tested in vitro by using ox bile. A prospective randomized trial in human beings was conducted.

SETTING: Tertiary medical center.

PATIENTS: Patients with malignant bile-duct strictures were studied.

INTERVENTIONS: A PBS or an AR-PBS stent was placed by using standard techniques, and the patients were followed at regular intervals. Patients presenting with stent occlusion underwent re-stent placement with either a PBS or a metal stent.

MAIN OUTCOME MEASUREMENTS: In vitro: resistance to retrograde flow and comparison of the basal and peak antegrade flow pressures between the 2 stents. In vivo: stent patency rates, complications, and the efficacy of the stents in improving the liver test.

RESULTS: The AR-PBS stent could withstand a retrograde pressure gradient of >320 mm Hg compared with <1 mm Hg for the PBS. Secondary to the siphon effect of the valve, the antegrade flow resistance offered by the AR-PBS was on the negative side for all flow rates compared with PBS (P < .001). The median patency of the AR-PBS in human studies was 145 days (range, 52-252 days) compared with 101 days (range, 41-210 days) for the PBS (P = .002). Both stents were equally effective in improving the liver test, and complication rates were similar in the 2 groups.

LIMITATIONS: The occluded stents were not examined microscopically.

CONCLUSIONS: The antireflux biliary stent remains patent for a longer time and hence duodenobiliary reflux may be contributing to stent occlusion.

Author List

Dua KS, Reddy ND, Rao VG, Banerjee R, Medda B, Lang I

Author

Kulwinder S. Dua MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Animals
Bile Reflux
Biliary Tract
Cattle
Cholestasis
Constriction, Pathologic
Drainage
Equipment Design
Equipment Failure
Female
Humans
Male
Middle Aged
Prospective Studies
Rheology
Stents