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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.

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.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

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

doi

10.1016/j.gie.2006.09.011

subject

Has Abstract

pub_date

2007-05-01 00:00:00

pages

819-28

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(06)02921-X

journal_volume

pub_type

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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.