Self-expandable biodegradable biliary stents in porcine model.

BACKGROUND Treatment or prevention of a benign biliary tree stricture is an unresolved problem. A novel self-expandable biodegradable polydioxanon biliary stent in a porcine model was studied. MATERIALS AND METHODS This new stent was used in 23 pigs. Feasibility and safety of surgical stenting, time of biodegradation, and histologic reaction in 2, 8, 13, and 20 wk of a follow-up were studied. All stents were inserted into a common bile duct through a duodenal papilla following small dilatation. After surgical evaluation of abdominal cavities, the pigs were sacrificed to remove common bile ducts with the stents. All bile ducts were assessed by macroscopic and histopathologic examination. RESULTS Self-expansion was correct in all cases. Neither bile duct obstruction nor postsurgical complications were observed. Macroscopic evaluation indicated lightening of the stent color in 2 wk, a partial disintegration in 8 wk, and a complete absorption in 13 and 20 wk. Histologic evaluation in general substantiated a mild-to-moderate inflammatory reaction in the lamina propria during the whole follow up and had no clinical consequences. No cholangitis, necrosis, abscess, or excessive fibroplasia was found in a hepatoduodenal ligament. CONCLUSIONS Our results suggest that polydioxanon biodegradable self-expanding stents seem to be useful for biliary system implantation, offer a good biocompatibility, and completely degrade within 13 wk.

[1]  Y. Lv,et al.  Interest of a new biodegradable stent coated with paclitaxel on anastomotic wound healing after biliary reconstruction , 2013, European journal of gastroenterology & hepatology.

[2]  J. Baillie.  Clinical Trial Report: Endoscopic Treatment of Postoperative Bile Duct Strictures Using Multiple Stents: Long-Term Results , 2011, Current gastroenterology reports.

[3]  M. Talamini,et al.  Postoperative Bile Duct Strictures: Management and Outcome in the 1990s , 2000, Annals of surgery.

[4]  J. Pekolj,et al.  Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. , 2013, Journal of the American College of Surgeons.

[5]  A. Fingerhut,et al.  Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. , 2012, American Journal of Surgery.

[6]  Jin-bo Gao,et al.  Role of Kasai procedure in surgery of hilar bile duct strictures. , 2011, World journal of gastroenterology.

[7]  T. Asahara,et al.  Synthetic bioabsorbable stent material for duct-to-duct biliary reconstruction. , 2009, The Journal of surgical research.

[8]  Yunfeng Cui,et al.  Surgical treatment for benign biliary strictures: single-center experience on 64 cases , 2012, EXCLI journal.

[9]  K. Sung,et al.  Percutaneous Transhepatic Treatment Using Retrievable Covered Stents in Patients with Benign Biliary Strictures: Mid-term Outcomes in 68 Patients , 2013, Digestive Diseases and Sciences.

[10]  L. Novotný,et al.  Novel biodegradable polydioxanone stents in a rabbit airway model. , 2012, The Journal of thoracic and cardiovascular surgery.

[11]  J. Laukkarinen,et al.  Biodegradable Biliary Stent in the Endoscopic Treatment of Cystic Duct Leakage After Cholecystectomy , 2005 .

[12]  B. Jabłońska,et al.  Iatrogenic bile duct injuries: etiology, diagnosis and management. , 2009, World journal of gastroenterology.

[13]  M. Crowell,et al.  Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy. , 2007, Gastrointestinal endoscopy.

[14]  K. Vasiliadis,et al.  A single center experience in minimally invasive treatment of postcholecystectomy bile leak, complicated with biloma formation. , 2007, The Journal of surgical research.

[15]  G. Ginsberg,et al.  In vivo evaluation of a new bioabsorbable self-expanding biliary stent. , 2003, Gastrointestinal endoscopy.

[16]  K. Kichikawa,et al.  Experimental Study of Poly-l-Lactic Acid Biodegradable Stents in Normal Canine Bile Ducts , 2011, CardioVascular and Interventional Radiology.

[17]  S. Connor,et al.  Bile duct injury in the era of laparoscopic cholecystectomy , 2006, The British journal of surgery.

[18]  Lijun Tang,et al.  Progressive balloon dilatation following hepaticojejunostomy improves outcome of bile duct stricture after iatrogenic biliary injury , 2013, BMC Gastroenterology.

[19]  D. Adams,et al.  Management of biliary strictures due to laparoscopic cholecystectomy. , 1995, The Journal of surgical research.

[20]  Y. Kluger,et al.  Endoscopic sphincterotomy and temporary internal stenting for bile leaks following complex hepatic trauma , 2006, The British journal of surgery.

[21]  H. Laasch,et al.  Management of Benign Biliary Strictures , 2002, CardioVascular and Interventional Radiology.

[22]  L. Solbiati,et al.  Biodegradable biliary stent implantation in the treatment of benign bilioplastic-refractory biliary strictures: preliminary experience , 2013, European Radiology.

[23]  V. Kapoor,et al.  Postcholecystectomy Benign Biliary Strictures – Long-Term Results , 2007, Digestive Surgery.

[24]  A. Behari,et al.  Factors Predicting Failure Following High Bilio-enteric Anastomosis for Post-cholecystectomy Benign Biliary Strictures , 2010, Journal of Gastrointestinal Surgery.

[25]  A. Behari,et al.  Risk Factors for Development of Biliary Stricture in Patients Presenting with Bile Leak after Cholecystectomy , 2013, Gut and liver.

[26]  J. García-Cano.  Endoscopic Management of Benign Biliary Strictures , 2013, Current Gastroenterology Reports.

[27]  A. A. Redwan.  Complex post-cholecystectomy biliary injuries: management with 10 years' experience in a major referral center. , 2012, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[28]  K. Lillemoe,et al.  Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy: a decade of experience. , 2004, Journal of the American College of Surgeons.

[29]  C. Prinz,et al.  Long-term Follow-up After Endoscopic Stent Therapy for Benign Biliary Strictures , 2014, Journal of clinical gastroenterology.

[30]  A. Y. Lee,et al.  Percutaneous Transhepatic Balloon Dilation of Biliary-Enteric Anastomotic Strictures after Surgical Repair of Iatrogenic Bile Duct Injuries , 2012, PloS one.

[31]  L. Lepre,et al.  The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures. , 1996, Annals of surgery.

[32]  B. Gridelli,et al.  Endoscopy after radiology: Two‐step combined therapy for biliary stricture after Roux‐en‐Y hepaticojejunostomy , 2012, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[33]  Inder Singh,et al.  Evaluation of fully covered self-expanding metal stents in benign biliary strictures and bile leaks. , 2013, World journal of gastrointestinal endoscopy.

[34]  R. Brůha,et al.  Management of benign intrahepatic bile duct strictures: initial experience with polydioxanone biodegradable stents. , 2010, Endoscopy.

[35]  P. Törmälä,et al.  Comparison of tissue reactions in the tracheal mucosa surrounding a bioabsorbable and silicone airway stents. , 1998, The Annals of thoracic surgery.

[36]  Yigang Chen,et al.  Technique for the safe placement of a biodegradable stent into the common bile duct of rabbits , 2013, Experimental and therapeutic medicine.

[37]  C. Prinz,et al.  Long-term outcome of endoscopic and/or percutaneous transhepatic therapy in patients with biliary stricture after orthotopic liver transplantation , 2009, Journal of Gastroenterology.

[38]  F. Prat,et al.  Endoscopic management of post-laparoscopic cholecystectomy biliary strictures. Long-term outcome in a multicenter study. , 2006, Gastroenterologie clinique et biologique.

[39]  Y. Abe,et al.  Endoscopic placement of a new short-term biodegradable pancreatic and biliary stent in an animal model: a preliminary feasibility study (with videos) , 2011, Journal of hepato-biliary-pancreatic sciences.