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Clogging of Biliary Stents: Mechanisms and Possible Solutions
Author(s) -
LEUNG Joseph W. C.,
BANEZ Virgilio P.
Publication year - 1990
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.1990.tb00364.x
Subject(s) - clogging , biliary sludge , stent , medicine , biliary stent , biofilm , lumen (anatomy) , antibiotics , calcium salts , bacteria , surgery , calcium , gallbladder , chemistry , biochemistry , genetics , biology , archaeology , history
Recurrent jaundice or cholangitis resulting from stent clogging is a late complication of endoscopic stenting for malignant biliary obstruction. The cause of clogging is blockage of the stent lumen by biliary sludge. Chemical analysis of this material revealed the presence of calcium bilirubinate, calcium palmitate, mucoproteins and unidentified insoluble materials. Electron microscopic examination of the sludge and stent surface revealed presence of microcolonies of bacteria forming a biofilm. In vitro studies showed that bacteria adhered to the stent surface within two hours of exposing the stent to bacreria. Bacterial B‐glucuronidase causes deconjugation of bilirubin diglucuronide resulting in precipitation of calcium bilirubinate which further contributes to sludge formation. Prevention of late stent clogging should aim at preventing bacterial adherence. The use of broad spectrum antibiotics may sterilize the biliary system but carries a risk of inducing resistant bacteria. Coating the stent surface with antibiotics, chemical or metallic ions may modify the surface and prevent bacterial adherence. In the absence of effective methods to prevent bacterial adherence and biofilm formation, the use of larger stents with bigger lumen may delay the process of clogging. Cleaning with guidewires or brush may unblock the stent but the effect is only temporary. Elective exchange of the stent at a regular interval may help to prevent this complication.