BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents,but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian...BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents,but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome,chronic obstructive pulmonary disease,alcoholic liver cirrhosis,portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis.On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention.CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents,with one causing perforation.In addition,we review the relevant literature on migrated stents.展开更多
BACKGROUND Malignant obstructive jaundice is mainly caused by cholangiocarcinoma.Only a few patients are indicated for surgical resection,and the 3-year survival rate is<50%.For patients who are not eligible for su...BACKGROUND Malignant obstructive jaundice is mainly caused by cholangiocarcinoma.Only a few patients are indicated for surgical resection,and the 3-year survival rate is<50%.For patients who are not eligible for surgery,biliary stent placement can relieve biliary obstruction and improve liver function and quality of life.However,restenosis after biliary stents has a poor prognosis and is a clinical challenge.Biliary stent combined with iodine-125(125I)seed implantation can prolong stent patency and improve survival.AIM To evaluate the safety and efficacy of biliary stent combined with 125I seed strand implantation in malignant obstructive jaundice.METHODS We enrolled 67 patients between January 2016 and June 2018 with malignant obstructive jaundice and randomized them into a biliary stent combined with 125I seed strand treatment(combined)group(n=32)and biliary stent(control)group(n=35).All patients underwent enhanced computed tomography and magnetic resonance imaging and were tested for biochemical and cancer markers.Twelve patients underwent pathological examination before surgery.All patients were followed up by telephone or clinical visit.Postoperative liver function improvement,postoperative complications,stent patency time,and survival time were compared between the two groups.Prognostic risk factors were evaluated.RESULTS Technical success was achieved in all patients in both groups.Postoperative liver function improved significantly in all patients(total bilirubin,direct bilirubin,alanine aminotransferase,and aspartate aminotransferase decreased significantly in all patients,the P values were less than 0.05).There was no significant difference in preoperative or postoperative indexes between the two groups for changes in total bilirubin(P=0.147),direct bilirubin(P=0.448),alanine aminotransferase(P=0.120),and aspartate aminotransferase(P=0.387)between the two groups.The median stent patency time of the combined group was 9.0±1.4 mo[95%confidence interval(CI):6.3-11.8 mo],which was significantly longer than the that of the control group(6.0±0.3 mo,95%CI:5.5-6.5 mo,P=0.000).The median survival time of the combined group was 11.0±1.4 mo(95%CI:8.2-13.7 mo),which was significantly longer than that of the control group(7.0±0.3 mo,95%CI:6.4-7.6 mo,P=0.000).Location of obstruction and number of stents were independent risk factors affecting prognosis.CONCLUSION Biliary stent combined with 125I seed strand implantation is safe and effective in malignant obstructive jaundice and improves stent patency time and median survival time.展开更多
BACKGROUND： One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over- growth of bacteria. This study aimed to evaluate the feasibility of a novel silver=nanoparticle...BACKGROUND： One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over- growth of bacteria. This study aimed to evaluate the feasibility of a novel silver=nanoparticle-coated polyurethane （Ag/PU） stent in bacterial cholangitis model in swine. METHODS： Ag/PU was designed by coating silver nanopar- tides on polyurethane （PU） stent. Twenty-four healthy pigs with bacterial cholangitis using Ag/PU and PU stents were ran- domly divided into an Ag/PU stent group （n=12） and a PU stem group （n=12）, respectively. The stents were inserted by standard endoscopic retrograde cholangiopancreatography. Laboratory assay was performed for white blood cell （WBC） count, alanine aminotransferase （ALT）, interleukin-1 [l （IL- 1 p）, tumor necrosis factor-a （TNF-~） at baseline time, 8 hours, 1, 2, 3, and 7 days after stent placements. The segment of bile duct containing the stent was examined histologically ex vivo. Implanted bili- ary stents were examined by a scan electron microscope. The amount of silver release was also measured in vitro. RESULTS： The number of inflammatory cells and level of ALT, IL-1β and TNF-α were significantly lower in the Ag/PU stent group than in the PU stent group. Hyperplasia of the mucosa was more severe in the PU stent group than in the Ag/PU stent group. In contrast to the biofilm of bacteria on the PU stent, fewer bacteria adhered to the Ag/PU stent. CONCLUSIONS： PU biliary stents modified with silver nanoparticles are able to alleviate the inflammation of pigs with bacterial cholangitis. Silver-nanoparticle-coated stents are resistant to bacterial adhesion.展开更多
AIMTo evaluate complications and management outcomes of retained long-term plastic biliary stents.METHODSEndoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between...AIMTo evaluate complications and management outcomes of retained long-term plastic biliary stents.METHODSEndoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between January 2000 and December 2014. Follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients. We retrospectively examined the cause of biliary stent insertion, status of stents, complications associated with biliary stents and management outcomes of long-term plastic biliary stents. Continuous variables were analyzed using the t test. Observed frequencies in subsets of the study population were compared using Fisher’s exact test and χ<sup>2</sup> tests. Statistical significance was defined as P < 0.05 (two-tailed).RESULTSMean age of patients was 73.7 ± 12 years and male-to-female ratio was 2.2:1. Indications of plastic biliary stent insertion were bile duct stones (63.2%, 24/38) and benign bile duct stricture (52.6%, 20/38). Mean duration of retained plastic stent was 22.6 ± 12.2 mo, and in 10 cases (26.3%), stents were retained for more than 24 mo. Common bile duct (CBD) stones or sludge were found in most cases (92.1%, 35/38). The most common complication was acute cholangitis (94.7%, 36/38). Stent removal by endoscopic approach was successfully performed in 92.1% (35/38) of the cases. In 3 cases, an additional plastic stent was inserted alongside the previous stent due to failure of the stent removal. Endoscopic removal of bile duct stones was successful in 73.7% (28/38) of the cases. When patients were divided into two groups by duration of stent placement (12 to 24 mo vs over 24 mo), there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents.CONCLUSIONThe most common complication of retained long-term plastic biliary stents was acute cholangitis associated with CBD stones. Endoscopic management was successfully performed in most cases.展开更多
AIMTo investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODSTen consecutive patients with stones in the pancreatic head an...AIMTo investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODSTen consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared. RESULTSEndoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo. CONCLUSIONSequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy.展开更多
Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplan...Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation(OLT).Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures.We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT,who had successful temporary placement of a prototype removable covered self-expandable metal stent(RCSEMS).These 2 patients(both men,aged 44 and 53 years)were given temporary placement of a prototype RCSEMS (8.5 Fr gauge delivery system,8 mm×40 mm stent dimensions)in the common bile duct across the biliary stricture.There was no morbidity associated with stent placement and removal in these 2 cases.Clinical parameters improved after the RCSEMS placement.Longterm biliary patency was achieved in both the patients. No further biliary intervention was required within 14 and 18 mo follow-up after stent removal.展开更多
AIM: To review the usefulness of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma and identify problems that may need to be addressed.
Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery. Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube ca...Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery. Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.展开更多
Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibi...Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly diff icult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequently required aggressive antifungal administration along with endoscopic and radiologic interventions. This report also reviews approaches previously undertaken to manage severe obstructing fungal cholangitis.展开更多
AIM: To determine the impact (morbidity/mortality) of biliary stent-related events (SRE) (cholangitis or stent obstruction) in chemotherapy-treated pancreatico-biliary patients.METHODS: All consecutive patients with a...AIM: To determine the impact (morbidity/mortality) of biliary stent-related events (SRE) (cholangitis or stent obstruction) in chemotherapy-treated pancreatico-biliary patients.METHODS: All consecutive patients with advanced pancreatobiliary cancer and a biliary stent in-situ prior to starting palliative chemotherapy were identified retrospectively from local electronic case-note records (Jan 13 to Jan 15). The primary end-point was SRE rate and the time-to-SRE (defined as time from first stenting before chemotherapy to date of SRE). Progression-free survival and overall survival were measured from the time of starting chemotherapy. Kaplan-Meier, Cox and Fine-Gray regression (univariate and multivariable) analyses were employed, as appropriate. For the analysis of time-to-SRE, death was considered as a competing event.RESULTS: Ninety-six out of 693 screened patients were eligible; 89% had a metal stent (the remainder were plastic). The median time of follow-up was 9.6 mo (range 2.2 to 26.4). Forty-one patients (43%) developed a SRE during follow-up [cholangitis (39%), stent obstruction (29%), both (32%)]. There were no significant differences in baseline characteristics between the SRE group and no-SRE groups. Recorded SRE-consequences were: none (37%), chemotherapy delay (24%), discontinuation (17%) and death (22%). The median time-to-SRE was 4.4 mo (95%CI: 3.6-5.5). Patients with severe comorbidities (P < 0.001) and patients with ≥ 2 baseline stents/biliary procedures [HR = 2.3 (95%CI: 1.2-4.44), P = 0.010] had a shorter time-to-SRE on multivariable analysis. Stage was an independent prognostic factor for overall survival (P = 0.029) in the multivariable analysis adjusted for primary tumour site, performance status and development of SRE (SRE group vs no-SRE group).CONCLUSION: SREs are common and impact on patient’s morbidity. Our results highlight the need for prospective studies exploring the role of prophylactic strategies to prevent/delay SREs.展开更多
AIM:To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents(SEMS).METHODS:All SEMS had been placed for distal biliary strictures.Twenty-seven endoscopic procedures wer...AIM:To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents(SEMS).METHODS:All SEMS had been placed for distal biliary strictures.Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS(one uncovered and 18 covered) removal had been attempted,and 8 patients in whom stent trimming using argon plasma coagulation(APC) had been attempted at Tokyo Medical University Hospital.The APC settings were:voltage 60-80 W and gas flow at 1.5 L/min.RESULTS:The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d(range,8-280 d).Of the 19 patients in whom removal of the SEMS had been attempted,the procedure was successful in 14(73.7%) without procedure-related adverse events.The indwelling period in the stent removable group was shorter than that in the unremovable group(94.9 ± 71.5 d vs 166.2 ± 76.2 d,P = 0.08).Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage.Trimming time ranged from 11 to 16 min.CONCLUSION:Although further investigations on larger numbers of cases are necessary to accumulate evidence,the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.展开更多
In endoscopic placement of multiple plastic biliary stents (PBSs),we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion.We describe the case of a 79-year-old male with o...In endoscopic placement of multiple plastic biliary stents (PBSs),we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion.We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis.Although proximal dislocation of the first PBS was observed,we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire.We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath.It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb.Here we introduce this "anchor-wire technique",which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.展开更多
To evaluate the effect of targeting to hepatoma treated by magnetic biliary stent combining with magnetic nanoparticle containing 5-fluorouracil （5-FU）, thirty-two nude mice modes with transplanted hepatoma were div...To evaluate the effect of targeting to hepatoma treated by magnetic biliary stent combining with magnetic nanoparticle containing 5-fluorouracil （5-FU）, thirty-two nude mice modes with transplanted hepatoma were divided equally into four groups randomly. Experimental group received magnetic biliary stent and magnetic nanoparticles containing 5-FU. The tumor volume and pathomorphology of all groups was measured. The tumor control rate of the experimental group provided magnetic biliary stent wires and magnetic nanoparticles containing 5-FU is remarkably higher than three other control groups, showing significant curative effect. More apoptosis of tumor cells could be detected easily in experimental group. There are more apoptotic bodies and phagotrophic magnetic particle in apoptosis cells of experimental group under electron microscope. Magnetic biliary stent combining with magnetic nanoparticle containing 5-FU could inhibit the growth of hepatoma, and its curative effect is more remarkable than the traditional methods based on external magnetic fields.展开更多
Bacterial infection plays an important role in the initiation of biliary sludge formation. Bacterial adherence and biofilm formation on the surface of a material have been considered as one of the main factors of sten...Bacterial infection plays an important role in the initiation of biliary sludge formation. Bacterial adherence and biofilm formation on the surface of a material have been considered as one of the main factors of stent re-occlusion in clinic. This work reported preventing bacterial adherence and bacterial biofilm formation on the surface of biliary stent material using chitosan film. The chitosan film was deposited on 316 L stainless steel （SS） plate by electrophoresis method and was characterized by X-ray diffraction （XRD）, Fourier Transform infrared spectroscopy （FTIR） and atomic force microscopy （AFM）. The ability of inhibiting bacterial adherence was investigated by incubating in human fresh bile adding E. coli and Enterobacter at 37±1 ℃ . Scanning electron microscopy （SEM） and fluorescence staining were used for observing bacterial colonization and biofilm formation. The results show that chitosan film was uniformly deposited on material surface, and the composition of the film did not change through cross-linking, but the crystallinity of chitosan film become well. Comparing to un-modified sample, the E. coli and Enterococcus adhesion amount and colonization on the surface of modified sample were significantly decreased by fluorescence staining and SEM. It is suggested that chitosan could be applied to biliary stent in clinical because of its antimicrobial activities.展开更多
Biliary stenting is an important interventional method for the prevention and treatment of biliary tract diseases.However,complications,such as postoperative biliary infection and re-stenosis,frequently occur due to t...Biliary stenting is an important interventional method for the prevention and treatment of biliary tract diseases.However,complications,such as postoperative biliary infection and re-stenosis,frequently occur due to the extensive scope of the biliary system and the complex composition of bile.The com-bination of coating technology and biliary stents is expected to bring new approaches to the solution of these problems.The cutting-edge advance on functional coatings on biliary stents is reviewed from seven perspectives:anticorrosion,-bacterial,-tumor,stone-dissolving,X-ray visibility,anti-stent migration and functional composite coatings.The de-velopment trend is also discussed.Overall.the performance of the numerous functional coatings for various purposes is generally up to expectations,but the balance between the medica tions'effectiveness and their safety needs to be further adjusted.Many contemporary investigations have advanced to the leve of animal experiments,offering crucial fundamental assurance for broader human studies.The combination of biliary stent and functional coatings is an innovative idea with great potential for future development.展开更多
Biliary strictures are characterized by the narrowing of the bile duct lumen,usually caused by surgical biliary injury,cancer,inflammation,and scarring from gallstones.Endoscopic stent placement is a well-established ...Biliary strictures are characterized by the narrowing of the bile duct lumen,usually caused by surgical biliary injury,cancer,inflammation,and scarring from gallstones.Endoscopic stent placement is a well-established method for the management of biliary strictures.However,maintaining optimal mechanical properties of stents and designing surfaces that can prevent stent-induced tissue hyperplasia and biofilm formation are challenges in the fabrication of biodegradable biliary stents(BBSs)for customized treatment.This study proposes a novel approach to fabricating functionalized polymer BBSs with nanoengineered surfaces using 3D printing.The 3D printed stents,fabricated from bioactive silica poly(ε-carprolactone)(PCL)via a sol-gel method,exhibited tunable mechanical properties suitable for supporting the bile duct while ensuring biocompatibility.Furthermore,a nanoengineered surface layer was successfully created on a sirolimus(SRL)-coated functionalized PCL(fPCL)stent using Zn ion sputtering-based plasma immersion ion implantation(S-PIII)treatment to enhance the performance of the stent.The nanoengineered surface of the SRL-coated fPCL stent effectively reduced bacterial responses and remarkably inhibited fibroblast proliferation and initial burst release of SRL in vitro systems.The physicochemical properties and biological behaviors,including in vitro biocompatibility and in vivo therapeutic efficacy in the rabbit bile duct,of the Zn-SRL@fPCL stent demonstrated its potential as a versatile platform for clinical applications in bile duct tissue engineering.展开更多
Demand for biliary stents has expanded with the increasing incidence of biliary disease.The implantation of plastic or self-expandable metal stents can be an effective treatment for biliary strictures.However,these st...Demand for biliary stents has expanded with the increasing incidence of biliary disease.The implantation of plastic or self-expandable metal stents can be an effective treatment for biliary strictures.However,these stents are nondegradable and prone to restenosis.Surgical removal or replacement of the nondegradable stents is necessary in cases of disease resolution or restenosis.To overcome these shortcomings,improvements were made to the materials and surfaces used for the stents.First,this paper reviews the advantages and limitations of nondegradable stents.Second,emphasis is placed on biodegradable polymer and biodegradable metal stents,along with functional coatings.This also encompasses tissue engineering&3D-printed stents were highlighted.Finally,the future perspectives of biliary stents,including pro-epithelialization coatings,multifunctional coated stents,biodegradable shape memory stents,and 4D bioprinting,were discussed.展开更多
Patients with malignant biliary obstruction,following endoscopic retrograde cholangiopancreatography(ERCP)failure could be referred for endoscopicultrasound-guided biliary drainage through electrocautery-enhanced(ECE)...Patients with malignant biliary obstruction,following endoscopic retrograde cholangiopancreatography(ERCP)failure could be referred for endoscopicultrasound-guided biliary drainage through electrocautery-enhanced(ECE)lumen-apposing metal stent(LAMS)placement.However,the efficacy and safety of ECE-LAMS in this scenario have remained debatable due to minimal scientific evidence.The current confirmed 91.0%clinical success,96.7%technical success,7.3%reintervention rate,and 17.5%adverse events,following the treatment of malignant biliary obstruction with ECE-LAMS delivery.Finally,ECE-LAMS proved to be a generalizable strategy for managing biliary obstruction for patients who were excluded from ERCP.展开更多
Benign biliary strictures(BBS)might occur due to different pancreaticobiliary conditions.The etiology and location of biliary strictures are responsible of a wide array of clinical manifestations.The endoscopic approa...Benign biliary strictures(BBS)might occur due to different pancreaticobiliary conditions.The etiology and location of biliary strictures are responsible of a wide array of clinical manifestations.The endoscopic approach endoscopic retrograde cholangiopancreatography represents the first-line treatment for BBS,considering interventional radiology and surgery when endoscopic treatment fails or it is not suitable.The purpose of this review is to provide an overview of possible endoscopic treatments for the optimal management of this subset of patients.展开更多
文摘BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents,but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome,chronic obstructive pulmonary disease,alcoholic liver cirrhosis,portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis.On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention.CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents,with one causing perforation.In addition,we review the relevant literature on migrated stents.
文摘BACKGROUND Malignant obstructive jaundice is mainly caused by cholangiocarcinoma.Only a few patients are indicated for surgical resection,and the 3-year survival rate is<50%.For patients who are not eligible for surgery,biliary stent placement can relieve biliary obstruction and improve liver function and quality of life.However,restenosis after biliary stents has a poor prognosis and is a clinical challenge.Biliary stent combined with iodine-125(125I)seed implantation can prolong stent patency and improve survival.AIM To evaluate the safety and efficacy of biliary stent combined with 125I seed strand implantation in malignant obstructive jaundice.METHODS We enrolled 67 patients between January 2016 and June 2018 with malignant obstructive jaundice and randomized them into a biliary stent combined with 125I seed strand treatment(combined)group(n=32)and biliary stent(control)group(n=35).All patients underwent enhanced computed tomography and magnetic resonance imaging and were tested for biochemical and cancer markers.Twelve patients underwent pathological examination before surgery.All patients were followed up by telephone or clinical visit.Postoperative liver function improvement,postoperative complications,stent patency time,and survival time were compared between the two groups.Prognostic risk factors were evaluated.RESULTS Technical success was achieved in all patients in both groups.Postoperative liver function improved significantly in all patients(total bilirubin,direct bilirubin,alanine aminotransferase,and aspartate aminotransferase decreased significantly in all patients,the P values were less than 0.05).There was no significant difference in preoperative or postoperative indexes between the two groups for changes in total bilirubin(P=0.147),direct bilirubin(P=0.448),alanine aminotransferase(P=0.120),and aspartate aminotransferase(P=0.387)between the two groups.The median stent patency time of the combined group was 9.0±1.4 mo[95%confidence interval(CI):6.3-11.8 mo],which was significantly longer than the that of the control group(6.0±0.3 mo,95%CI:5.5-6.5 mo,P=0.000).The median survival time of the combined group was 11.0±1.4 mo(95%CI:8.2-13.7 mo),which was significantly longer than that of the control group(7.0±0.3 mo,95%CI:6.4-7.6 mo,P=0.000).Location of obstruction and number of stents were independent risk factors affecting prognosis.CONCLUSION Biliary stent combined with 125I seed strand implantation is safe and effective in malignant obstructive jaundice and improves stent patency time and median survival time.
基金partially supported by grants from the Jiangsu Province Social Development Program(BL2012031)the National Natural Science Foundation of China(81172266)+1 种基金the Natural Science Foundation of Jiangsu Province(BK2011859)Jiangsu Innovation of Medical Team and Leading Talents Cultivation(LJ201127)
文摘BACKGROUND： One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over- growth of bacteria. This study aimed to evaluate the feasibility of a novel silver=nanoparticle-coated polyurethane （Ag/PU） stent in bacterial cholangitis model in swine. METHODS： Ag/PU was designed by coating silver nanopar- tides on polyurethane （PU） stent. Twenty-four healthy pigs with bacterial cholangitis using Ag/PU and PU stents were ran- domly divided into an Ag/PU stent group （n=12） and a PU stem group （n=12）, respectively. The stents were inserted by standard endoscopic retrograde cholangiopancreatography. Laboratory assay was performed for white blood cell （WBC） count, alanine aminotransferase （ALT）, interleukin-1 [l （IL- 1 p）, tumor necrosis factor-a （TNF-~） at baseline time, 8 hours, 1, 2, 3, and 7 days after stent placements. The segment of bile duct containing the stent was examined histologically ex vivo. Implanted bili- ary stents were examined by a scan electron microscope. The amount of silver release was also measured in vitro. RESULTS： The number of inflammatory cells and level of ALT, IL-1β and TNF-α were significantly lower in the Ag/PU stent group than in the PU stent group. Hyperplasia of the mucosa was more severe in the PU stent group than in the Ag/PU stent group. In contrast to the biofilm of bacteria on the PU stent, fewer bacteria adhered to the Ag/PU stent. CONCLUSIONS： PU biliary stents modified with silver nanoparticles are able to alleviate the inflammation of pigs with bacterial cholangitis. Silver-nanoparticle-coated stents are resistant to bacterial adhesion.
基金Supported by 2015 Yeungnam University Research Grant,No.215A380205
文摘AIMTo evaluate complications and management outcomes of retained long-term plastic biliary stents.METHODSEndoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between January 2000 and December 2014. Follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients. We retrospectively examined the cause of biliary stent insertion, status of stents, complications associated with biliary stents and management outcomes of long-term plastic biliary stents. Continuous variables were analyzed using the t test. Observed frequencies in subsets of the study population were compared using Fisher’s exact test and χ<sup>2</sup> tests. Statistical significance was defined as P < 0.05 (two-tailed).RESULTSMean age of patients was 73.7 ± 12 years and male-to-female ratio was 2.2:1. Indications of plastic biliary stent insertion were bile duct stones (63.2%, 24/38) and benign bile duct stricture (52.6%, 20/38). Mean duration of retained plastic stent was 22.6 ± 12.2 mo, and in 10 cases (26.3%), stents were retained for more than 24 mo. Common bile duct (CBD) stones or sludge were found in most cases (92.1%, 35/38). The most common complication was acute cholangitis (94.7%, 36/38). Stent removal by endoscopic approach was successfully performed in 92.1% (35/38) of the cases. In 3 cases, an additional plastic stent was inserted alongside the previous stent due to failure of the stent removal. Endoscopic removal of bile duct stones was successful in 73.7% (28/38) of the cases. When patients were divided into two groups by duration of stent placement (12 to 24 mo vs over 24 mo), there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents.CONCLUSIONThe most common complication of retained long-term plastic biliary stents was acute cholangitis associated with CBD stones. Endoscopic management was successfully performed in most cases.
文摘AIMTo investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODSTen consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared. RESULTSEndoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo. CONCLUSIONSequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy.
文摘Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation(OLT).Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures.We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT,who had successful temporary placement of a prototype removable covered self-expandable metal stent(RCSEMS).These 2 patients(both men,aged 44 and 53 years)were given temporary placement of a prototype RCSEMS (8.5 Fr gauge delivery system,8 mm×40 mm stent dimensions)in the common bile duct across the biliary stricture.There was no morbidity associated with stent placement and removal in these 2 cases.Clinical parameters improved after the RCSEMS placement.Longterm biliary patency was achieved in both the patients. No further biliary intervention was required within 14 and 18 mo follow-up after stent removal.
文摘AIM: To review the usefulness of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma and identify problems that may need to be addressed.
文摘Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery. Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.
文摘Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly diff icult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequently required aggressive antifungal administration along with endoscopic and radiologic interventions. This report also reviews approaches previously undertaken to manage severe obstructing fungal cholangitis.
基金Supported by Pancreatic Cancer Research Fund and Spanish society of Medical Oncology(Lamarca A)
文摘AIM: To determine the impact (morbidity/mortality) of biliary stent-related events (SRE) (cholangitis or stent obstruction) in chemotherapy-treated pancreatico-biliary patients.METHODS: All consecutive patients with advanced pancreatobiliary cancer and a biliary stent in-situ prior to starting palliative chemotherapy were identified retrospectively from local electronic case-note records (Jan 13 to Jan 15). The primary end-point was SRE rate and the time-to-SRE (defined as time from first stenting before chemotherapy to date of SRE). Progression-free survival and overall survival were measured from the time of starting chemotherapy. Kaplan-Meier, Cox and Fine-Gray regression (univariate and multivariable) analyses were employed, as appropriate. For the analysis of time-to-SRE, death was considered as a competing event.RESULTS: Ninety-six out of 693 screened patients were eligible; 89% had a metal stent (the remainder were plastic). The median time of follow-up was 9.6 mo (range 2.2 to 26.4). Forty-one patients (43%) developed a SRE during follow-up [cholangitis (39%), stent obstruction (29%), both (32%)]. There were no significant differences in baseline characteristics between the SRE group and no-SRE groups. Recorded SRE-consequences were: none (37%), chemotherapy delay (24%), discontinuation (17%) and death (22%). The median time-to-SRE was 4.4 mo (95%CI: 3.6-5.5). Patients with severe comorbidities (P < 0.001) and patients with ≥ 2 baseline stents/biliary procedures [HR = 2.3 (95%CI: 1.2-4.44), P = 0.010] had a shorter time-to-SRE on multivariable analysis. Stage was an independent prognostic factor for overall survival (P = 0.029) in the multivariable analysis adjusted for primary tumour site, performance status and development of SRE (SRE group vs no-SRE group).CONCLUSION: SREs are common and impact on patient’s morbidity. Our results highlight the need for prospective studies exploring the role of prophylactic strategies to prevent/delay SREs.
文摘AIM:To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents(SEMS).METHODS:All SEMS had been placed for distal biliary strictures.Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS(one uncovered and 18 covered) removal had been attempted,and 8 patients in whom stent trimming using argon plasma coagulation(APC) had been attempted at Tokyo Medical University Hospital.The APC settings were:voltage 60-80 W and gas flow at 1.5 L/min.RESULTS:The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d(range,8-280 d).Of the 19 patients in whom removal of the SEMS had been attempted,the procedure was successful in 14(73.7%) without procedure-related adverse events.The indwelling period in the stent removable group was shorter than that in the unremovable group(94.9 ± 71.5 d vs 166.2 ± 76.2 d,P = 0.08).Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage.Trimming time ranged from 11 to 16 min.CONCLUSION:Although further investigations on larger numbers of cases are necessary to accumulate evidence,the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.
文摘In endoscopic placement of multiple plastic biliary stents (PBSs),we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion.We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis.Although proximal dislocation of the first PBS was observed,we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire.We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath.It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb.Here we introduce this "anchor-wire technique",which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.
基金Funded by the Hi-Tech Research and Development Program of China(No.2002AA214061)
文摘To evaluate the effect of targeting to hepatoma treated by magnetic biliary stent combining with magnetic nanoparticle containing 5-fluorouracil （5-FU）, thirty-two nude mice modes with transplanted hepatoma were divided equally into four groups randomly. Experimental group received magnetic biliary stent and magnetic nanoparticles containing 5-FU. The tumor volume and pathomorphology of all groups was measured. The tumor control rate of the experimental group provided magnetic biliary stent wires and magnetic nanoparticles containing 5-FU is remarkably higher than three other control groups, showing significant curative effect. More apoptosis of tumor cells could be detected easily in experimental group. There are more apoptotic bodies and phagotrophic magnetic particle in apoptosis cells of experimental group under electron microscope. Magnetic biliary stent combining with magnetic nanoparticle containing 5-FU could inhibit the growth of hepatoma, and its curative effect is more remarkable than the traditional methods based on external magnetic fields.
基金Supported by Key Basic Research Project of China (No. 2005CB623904)National Natural Science Foundation of China (No.RGC30831160509)Program for New Century Excellent Talents in University (No.06-0800)
文摘Bacterial infection plays an important role in the initiation of biliary sludge formation. Bacterial adherence and biofilm formation on the surface of a material have been considered as one of the main factors of stent re-occlusion in clinic. This work reported preventing bacterial adherence and bacterial biofilm formation on the surface of biliary stent material using chitosan film. The chitosan film was deposited on 316 L stainless steel （SS） plate by electrophoresis method and was characterized by X-ray diffraction （XRD）, Fourier Transform infrared spectroscopy （FTIR） and atomic force microscopy （AFM）. The ability of inhibiting bacterial adherence was investigated by incubating in human fresh bile adding E. coli and Enterobacter at 37±1 ℃ . Scanning electron microscopy （SEM） and fluorescence staining were used for observing bacterial colonization and biofilm formation. The results show that chitosan film was uniformly deposited on material surface, and the composition of the film did not change through cross-linking, but the crystallinity of chitosan film become well. Comparing to un-modified sample, the E. coli and Enterococcus adhesion amount and colonization on the surface of modified sample were significantly decreased by fluorescence staining and SEM. It is suggested that chitosan could be applied to biliary stent in clinical because of its antimicrobial activities.
基金supported by the Natural Science Foundation of Shandong Province,China(ZR 2020ME011).
文摘Biliary stenting is an important interventional method for the prevention and treatment of biliary tract diseases.However,complications,such as postoperative biliary infection and re-stenosis,frequently occur due to the extensive scope of the biliary system and the complex composition of bile.The com-bination of coating technology and biliary stents is expected to bring new approaches to the solution of these problems.The cutting-edge advance on functional coatings on biliary stents is reviewed from seven perspectives:anticorrosion,-bacterial,-tumor,stone-dissolving,X-ray visibility,anti-stent migration and functional composite coatings.The de-velopment trend is also discussed.Overall.the performance of the numerous functional coatings for various purposes is generally up to expectations,but the balance between the medica tions'effectiveness and their safety needs to be further adjusted.Many contemporary investigations have advanced to the leve of animal experiments,offering crucial fundamental assurance for broader human studies.The combination of biliary stent and functional coatings is an innovative idea with great potential for future development.
基金supported by the National Research Foundation of Korea (NRF)grant funded by the Korea government (MSIT) (Nos.2021R1I1A1A01043176,2022R1C1C1003205,2023R1A2C1007779,and 2021R1A2C1091301)the Korea Medical Device Development Fund grant funded by the Korea government (Ministry of Science and ICT,Ministry of Trade,Industry and Energy,Ministry of Health&Welfare,Ministry of Food and Drug Safety,Project Number:RS-2023-00238092)Korean Fund for Regenerative Medicine (KFRM)grant funded by the Korea government (the Ministry of Science and ICT,the Ministry of Health&Welfare,KFRM 24A0105L1).
文摘Biliary strictures are characterized by the narrowing of the bile duct lumen,usually caused by surgical biliary injury,cancer,inflammation,and scarring from gallstones.Endoscopic stent placement is a well-established method for the management of biliary strictures.However,maintaining optimal mechanical properties of stents and designing surfaces that can prevent stent-induced tissue hyperplasia and biofilm formation are challenges in the fabrication of biodegradable biliary stents(BBSs)for customized treatment.This study proposes a novel approach to fabricating functionalized polymer BBSs with nanoengineered surfaces using 3D printing.The 3D printed stents,fabricated from bioactive silica poly(ε-carprolactone)(PCL)via a sol-gel method,exhibited tunable mechanical properties suitable for supporting the bile duct while ensuring biocompatibility.Furthermore,a nanoengineered surface layer was successfully created on a sirolimus(SRL)-coated functionalized PCL(fPCL)stent using Zn ion sputtering-based plasma immersion ion implantation(S-PIII)treatment to enhance the performance of the stent.The nanoengineered surface of the SRL-coated fPCL stent effectively reduced bacterial responses and remarkably inhibited fibroblast proliferation and initial burst release of SRL in vitro systems.The physicochemical properties and biological behaviors,including in vitro biocompatibility and in vivo therapeutic efficacy in the rabbit bile duct,of the Zn-SRL@fPCL stent demonstrated its potential as a versatile platform for clinical applications in bile duct tissue engineering.
基金supported by grants from the Fundamental Research Funds for the Central Universities(No.2024CDJCGJ-016)National Natural Science Foundation of China(No.82270535)+1 种基金the Science and Technology Innovation Project of Jinfeng Laboratory,Chongqing,China(jfkyjf202203001)China Postdoctoral Science Foundation(2023MD734198).
文摘Demand for biliary stents has expanded with the increasing incidence of biliary disease.The implantation of plastic or self-expandable metal stents can be an effective treatment for biliary strictures.However,these stents are nondegradable and prone to restenosis.Surgical removal or replacement of the nondegradable stents is necessary in cases of disease resolution or restenosis.To overcome these shortcomings,improvements were made to the materials and surfaces used for the stents.First,this paper reviews the advantages and limitations of nondegradable stents.Second,emphasis is placed on biodegradable polymer and biodegradable metal stents,along with functional coatings.This also encompasses tissue engineering&3D-printed stents were highlighted.Finally,the future perspectives of biliary stents,including pro-epithelialization coatings,multifunctional coated stents,biodegradable shape memory stents,and 4D bioprinting,were discussed.
文摘Patients with malignant biliary obstruction,following endoscopic retrograde cholangiopancreatography(ERCP)failure could be referred for endoscopicultrasound-guided biliary drainage through electrocautery-enhanced(ECE)lumen-apposing metal stent(LAMS)placement.However,the efficacy and safety of ECE-LAMS in this scenario have remained debatable due to minimal scientific evidence.The current confirmed 91.0%clinical success,96.7%technical success,7.3%reintervention rate,and 17.5%adverse events,following the treatment of malignant biliary obstruction with ECE-LAMS delivery.Finally,ECE-LAMS proved to be a generalizable strategy for managing biliary obstruction for patients who were excluded from ERCP.
文摘Benign biliary strictures(BBS)might occur due to different pancreaticobiliary conditions.The etiology and location of biliary strictures are responsible of a wide array of clinical manifestations.The endoscopic approach endoscopic retrograde cholangiopancreatography represents the first-line treatment for BBS,considering interventional radiology and surgery when endoscopic treatment fails or it is not suitable.The purpose of this review is to provide an overview of possible endoscopic treatments for the optimal management of this subset of patients.
