Plastic Biliary Stent Occlusion: Factors Involved and Possible Preventive Approaches

Endoscopic biliary stenting is today the most common palliative treatment for patients suffering from obstructive jaundice associated with malignant hepatobiliary tumors or benign strictures. However, recurrent jaundice, with or without cholangitis, is a major complication of a biliary endoprosthesis insertion. Thus, stent removal and replacement with a new one frequently occurs as a consequence of device blockage caused by microbial biofilm growth and biliary sludge accumulation in the lumen. Factors and mechanisms involved in plastic stent clogging arising from epidemiological, clinical and experimental data, as well as the possible strategies to prevent biliary stent failure, will be reviewed and discussed.

[1]  J. Costerton Overview of microbial biofilms , 1995, Journal of Industrial Microbiology.

[2]  J. Janssen,et al.  Why do bilioduodenal plastic stents become occluded? A clinical and pathological investigation on 100 consecutive patients. , 2001, Endoscopy.

[3]  A. Ljungh,et al.  Fibronectin on the surface of biliary drain materials--a role in bacterial adherence. , 1995, The Journal of surgical research.

[4]  G. Toti,et al.  Prospective randomized trial comparing Tannenbaum Teflon and standard polyethylene stents in distal malignant biliary stenosis. , 2000, Gastrointestinal endoscopy.

[5]  P. Cotton,et al.  Biliary stent blockage with bacterial biofilm. A light and electron microscopy study. , 1988, Annals of internal medicine.

[6]  F. Chan,et al.  Bile immunoglobulins and blockage of biliary endoprosthesis: an immunohistochemical study. , 1998, Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.

[7]  P. Macmathuna,et al.  Palliative biliary stents for obstructing pancreatic carcinoma. , 2006, The Cochrane database of systematic reviews.

[8]  J. Leung,et al.  The role of bacteria in the blockage of biliary stents. , 1988, Gastrointestinal endoscopy.

[9]  P. Craig,et al.  A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction. , 1995, Gut.

[10]  A. Cheng,et al.  Early attachment of anaerobic bacteria may play an important role in biliary stent blockage. , 2000, Gastrointestinal endoscopy.

[11]  P. Leung,et al.  Expression of bacterial β-glucuronidase in human bile: An in vitro study ☆ ☆☆ , 2001 .

[12]  Robert Fanelli,et al.  ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. , 2005, Gastrointestinal endoscopy.

[13]  J. Richer,et al.  Polyethylene stent blockage: a porcine model. , 2000, Gastrointestinal endoscopy.

[14]  G. Tytgat,et al.  Characterization of the Content of Occluded Biliary Endoprostheses , 1987, Endoscopy.

[15]  P. Cotton,et al.  Randomised trial of endoscopic steriting versus surgical bypass in malignant low bileduct obstruction , 1994, The Lancet.

[16]  K. Lewis,et al.  Riddle of Biofilm Resistance , 2001, Antimicrobial Agents and Chemotherapy.

[17]  T. Joh,et al.  Efficacy of Plastic Tube Stents Without Side Holes for Middle and Lower Biliary Strictures , 2002, Journal of clinical gastroenterology.

[18]  W. Luman,et al.  A combination of ciprofloxacin and Rowachol does not prevent biliary stent occlusion. , 1999, Gastrointestinal endoscopy.

[19]  T. Elliott,et al.  Role of antimicrobial-impregnated polymer and Teflon in the prevention of biliary stent blockage. , 1998, The Journal of hospital infection.

[20]  P. Leung,et al.  Expression of bacterial beta-glucuronidase in human bile: an in vitro study. , 2001, Gastrointestinal endoscopy.

[21]  G. Donelli,et al.  A microbiological and morphological study of blocked biliary stents , 1999 .

[22]  G. Rotondano,et al.  A Prospective, Randomized Multicenter Trial Comparing DoubleLayer and Polyethylene Stents for Malignant Distal Common Bile Duct Strictures , 2003, Endoscopy.

[23]  F. Halter,et al.  Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. , 1996, The American journal of gastroenterology.

[24]  Ali Diba,et al.  Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: A randomized trial , 1988, The British journal of surgery.

[25]  B. Jansen,et al.  Bacterial adherence to hydrophilic polymer-coated polyurethane stents. , 1993, Gastrointestinal endoscopy.

[26]  M. Catalano,et al.  "Tannenbaum" Teflon stents versus traditional polyethylene stents for treatment of malignant biliary stricture. , 2002, Gastrointestinal endoscopy.

[27]  D. Reddy,et al.  Antireflux biliary stents: Are they the solution to stent occlusions? , 2006, Current gastroenterology reports.

[28]  G. Donelli,et al.  Emerging Role of Enterococcus Spp in Catheter-Related Infections: Biofilm Formation and Novel Mechanisms of Antibiotic Resistance , 2004, The journal of vascular access.

[29]  J van Marle,et al.  Mechanisms of biliary stent clogging: confocal laser scanning and scanning electron microscopy. , 2005, Endoscopy.

[30]  J. Barkun,et al.  The role of ciprofloxacin in prolonging polyethylene biliary stent patency: A multicenter, double-blinded effectiveness study , 2005, Journal of Gastrointestinal Surgery.

[31]  J. Costerton,et al.  Decreased bacterial adherence to silver-coated stent material: an in vitro study. , 1992, Gastrointestinal endoscopy.

[32]  L. Carey,et al.  The role of polymeric surface smoothness of biliary stents in bacterial adherence, biofilm deposition, and stent occlusion. , 1993, Gastrointestinal endoscopy.

[33]  R. Kolter,et al.  Biofilm formation as microbial development. , 2000, Annual review of microbiology.

[34]  A. Li,et al.  Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial. , 1995, The Journal of antimicrobial chemotherapy.

[35]  J. Shah Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial , 2007 .

[36]  L. Costa,et al.  A chemical analysis of the clogging process of polymeric biliary endoprostheses. , 2001, Biomaterials.

[37]  H. J. Kolmos,et al.  Clogging of biliary endoprostheses. A morphologic and bacteriologic study. , 1991, Scandinavian journal of gastroenterology.

[38]  T. Barrioz,et al.  Randomised trial of prevention of biliary stent occlusion by ursodeoxycholic acid plus norfloxacin , 1994, The Lancet.

[39]  J. Leung,et al.  Prevention of biliary stent clogging: a clinical review. , 1996, The American journal of gastroenterology.

[40]  N Soehendra,et al.  Palliative Bile Duct Drainage - A New Endoscopic Method of Introducing a Transpapillary Drain , 1980, Endoscopy.

[41]  S. Kadakia,et al.  Comparison of 10 French gauge stent with 11.5 French gauge stent in patients with biliary tract diseases. , 1992, Gastrointestinal endoscopy.

[42]  T. Tsang,et al.  Bile glycoprotein mucin in sludge occluding biliary stent. , 2003, The Journal of laboratory and clinical medicine.

[43]  J. Costerton,et al.  Bacterial biofilm, brown pigment stone and blockage of biliary stents , 1993, Journal of gastroenterology and hepatology.

[44]  G. Donelli,et al.  Expression of slime interferes with in vitro detection of host protein receptors of Staphylococcus epidermidis , 1997, Infection and immunity.

[45]  T. Tsang,et al.  Inhibition of biliary endoprostheses occlusion by ampicillin-sulbactam in an in vitro model. , 1997, The Journal of laboratory and clinical medicine.

[46]  J. Devière,et al.  Risk factors for septicemia following endoscopic biliary stenting. , 1991, Gastroenterology.

[47]  G. Tytgat,et al.  Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis. , 1982, Gut.

[48]  S. Ghosh,et al.  Prevention of biliary stent occlusion using cyclical antibiotics and ursodeoxycholic acid. , 1994, Gut.

[49]  E. Alstead,et al.  Symptom relief and quality of life after stenting for malignant bile duct obstruction. , 1994, Gut.

[50]  T. Tsang,et al.  Silicone-Covered Metal Stents (An In Vitro Evaluation for Biofilm Formation and Patency) , 1999, Digestive Diseases and Sciences.

[51]  T. Maki Pathogenesis of calcium bilirubinate gallstone: role of E. coli, beta-glucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation. , 1966, Annals of surgery.

[52]  G. Christensen,et al.  Purification and characterization of the staphylococcal slime-associated antigen and its occurrence among Staphylococcus epidermis clinical isolates , 1996, Infection and immunity.

[53]  R. Kolter,et al.  Exopolysaccharide Production Is Required for Development of Escherichia coli K-12 Biofilm Architecture , 2000, Journal of bacteriology.

[54]  J. Costerton,et al.  Ascending infection of the biliary tract after surgical sphincterotomy and biliary stenting , 1992, Journal of gastroenterology and hepatology.

[55]  J. Bergman,et al.  Wallstents for metastatic biliary obstruction. , 1996, Endoscopy.

[56]  Anthony W Smith,et al.  Biofilms and antibiotic therapy: is there a role for combating bacterial resistance by the use of novel drug delivery systems? , 2005, Advanced drug delivery reviews.

[57]  G. Mclean,et al.  Role of endoprostheses in the management of malignant biliary obstruction. , 1989, Radiology.

[58]  K. Murata,et al.  Clostridium perfringens and other anaerobes isolated from bile. , 1983, Journal of clinical pathology.

[59]  H. Harmsen,et al.  Adhesion to Bile Drain Materials and Physicochemical Surface Properties of Enterococcus faecalis Strains Grown in the Presence of Bile , 2002, Applied and Environmental Microbiology.

[60]  F Cetta,et al.  New biliary endoprosthesis less liable to block in biliary infections: description and in vitro studies. , 1999, The European journal of surgery = Acta chirurgica.

[61]  Y. An,et al.  Concise review of mechanisms of bacterial adhesion to biomaterial surfaces. , 1998, Journal of biomedical materials research.

[62]  J. Llach,et al.  Percutaneous self-expanding metal stents versus endoscopic polyethylene endoprostheses for treating malignant biliary obstruction: randomized clinical trial. , 2002, Radiology.

[63]  R. Holzbach Nucleation of cholesterol crystals in native bile. , 1990, Hepatology.

[64]  J. Rey,et al.  Experimental Study of Biliary Endoprosthesis Efficiency , 1985, Endoscopy.

[65]  J. Costerton,et al.  Bacterial biofilms in nature and disease. , 1987, Annual review of microbiology.

[66]  J. Leung,et al.  Is there a synergistic effect between mixed bacterial infection in biofilm formation on biliary stents? , 1998, Gastrointestinal endoscopy.

[67]  P. Cotton,et al.  Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. , 1988, Gastrointestinal endoscopy.

[68]  G. Donelli,et al.  Sex Pheromone Response, Clumping, and Slime Production in Enterococcal Strains Isolated from Occluded Biliary Stents , 2004, Journal of Clinical Microbiology.

[69]  J. Costerton,et al.  Hydrophobic bile salt inhibits bacterial adhesion on biliary stent material , 1994, Digestive Diseases and Sciences.

[70]  J. van Marle,et al.  A scanning electron microscopic study of biliary stent materials. , 2000, Gastrointestinal endoscopy.

[71]  G. Donelli,et al.  Biliary stent occlusion : a microbiological and scanning electron microscopy (SEM) investigation , 1999 .

[72]  M. Deakin,et al.  A prospective randomised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton–Leung stents in patients with malignant common duct strictures , 2000, Gut.

[73]  H. Harmsen,et al.  Enterococcus faecalis surface proteins determine its adhesion mechanism to bile drain materials. , 2002, Microbiology.

[74]  In vitro evaluation of antibiotic prophylaxis in the prevention of biliary stent blockage. , 2000, Gastrointestinal endoscopy.

[75]  A. Ljungh,et al.  Protein adsorption and bacterial adhesion to biliary stent materials. , 1996, The Journal of surgical research.

[76]  B. Marano,et al.  Metallic biliary endoprosthesis causing duodenal perforation and acute upper gastrointestinal bleeding. , 1994, Gastrointestinal endoscopy.

[77]  R. Williamson,et al.  Surgical palliation for pancreatic cancer: developments during the past two decades , 1992, The British journal of surgery.

[78]  P. Cotton,et al.  RANDOMISED TRIAL OF ENDOSCOPIC VERSUS PERCUTANEOUS STENT INSERTION IN MALIGNANT OBSTRUCTIVE JAUNDICE , 1987, The Lancet.

[79]  D. Morck,et al.  Is prophylactic ciprofloxacin effective in delaying biliary stent blockage? , 2000, Gastrointestinal endoscopy.

[80]  D Bassler,et al.  Ursodeoxycholic acid and/or antibiotics for prevention of biliary stent occlusion. , 2002, The Cochrane database of systematic reviews.

[81]  Denis Sautereau,et al.  Physicochemical and bacteriological analysis of the contents of occluded biliary endoprostheses , 1991, Hepatology.

[82]  H. J. Kolmos,et al.  Experimental clogging of biliary endoprostheses. Role of bacteria, endoprosthesis material, and design. , 1992, Scandinavian journal of gastroenterology.

[83]  A. Kruse,et al.  Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. , 1989, Gut.