Dua KS, Reddy ND, Rao VG, Banerjee R, Medda B, Lang I. 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.
Gastrointest Endosc 2007;
65:819-28. [PMID:
17383650 DOI:
10.1016/j.gie.2006.09.011]
[Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2006] [Accepted: 09/05/2006] [Indexed: 12/27/2022]
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.
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