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Li Y, Yuan K, Deng C, Tang H, Wang J, Dai X, Zhang B, Sun Z, Ren G, Zhang H, Wang G. Biliary stents for active materials and surface modification: Recent advances and future perspectives. Bioact Mater 2024; 42:587-612. [PMID: 39314863 PMCID: PMC11417150 DOI: 10.1016/j.bioactmat.2024.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/27/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
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.
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Affiliation(s)
- Yuechuan Li
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, National Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Kunshan Yuan
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, National Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Chengchen Deng
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, National Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Hui Tang
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Jinxuan Wang
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, 610500, China
| | - Xiaozhen Dai
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, 610500, China
| | - Bing Zhang
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine (CVIHEM), Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Ziru Sun
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
- College of materials science and engineering, Shandong University of Technology, Zibo, 25500, Shandong, China
| | - Guiying Ren
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
- College of materials science and engineering, Shandong University of Technology, Zibo, 25500, Shandong, China
| | - Haijun Zhang
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, National Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, 610500, China
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine (CVIHEM), Drum Tower Hospital, Nanjing University, Nanjing, China
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Yang J, He Z, Zhang S, Zhao X, Sun J, Mao Z. Implementation of a simplified self-releasing biliary stent in choledocholithiasis: Experience in 150 cases. Asian J Endosc Surg 2020; 13:195-199. [PMID: 31074126 DOI: 10.1111/ases.12713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 03/04/2019] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Our aim was to introduce a simple way of making a self-releasing biliary stent for laparoscopic common biliary duct exploration. METHODS To make a self-releasing biliary stent, an absorbable thread was sutured to a J-shape polyurethane biliary stent. After the evacuation of the calculi, a guide wire was placed into the duodenum antegradely, facilitating the insertion of the biliary stent. The pigtail of the stent was left in the duodenum. The choledochotomy was then sutured, with the absorbable thread left outside the bile duct. RESULTS This study consisted of 150 patients with choledocholithiasis. The mean operating time was 126 ± 36 minutes. The postoperative hospital stay was 6.5 ± 3.6 days. In 149 cases, the biliary stents were released and discharged out of the body with feces. The inside body time of the rapid-releasing stent was 13.6 ± 2.6 days, and it was 28.0 ± 4.6 days for the slow-releasing stent. One stent was removed by endoscopy. Transient hyperamylasemia occurred in 32 patients (21.3%) without clinical onset of pancreatitis. Bile leakage occurred in three patients (2.0%), all of whom recovered after treatment. Residual lithiasis was found in one patient (0.7%) and was retracted by endoscopy 30 days after the first procedure. No infection or dislocation of the stent was found. CONCLUSION For laparoscopic common biliary duct exploration for choledocholithiasis, this method provides an alternative way to make a simple and safe self-releasing stent. It enables the endoscopic retraction of biliary stents to be avoided.
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Affiliation(s)
- Junfeng Yang
- Nantong Rich Hospital, Department of General Surgery, The Fourth Clinical College, Yangzhou University, Yangzhou, China
| | - Zirui He
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Sen Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Xuan Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Jing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Zhihai Mao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
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Girard E, Chagnon G, Broisat A, Dejean S, Soubies A, Gil H, Sharkawi T, Boucher F, Roth GS, Trilling B, Nottelet B. From in vitro evaluation to human postmortem pre-validation of a radiopaque and resorbable internal biliary stent for liver transplantation applications. Acta Biomater 2020; 106:70-81. [PMID: 32014582 DOI: 10.1016/j.actbio.2020.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 12/17/2022]
Abstract
The implantation of an internal biliary stent (IBS) during liver transplantation has recently been shown to reduce biliary complications. To avoid a potentially morbid ablation procedure, we developed a resorbable and radiopaque internal biliary stent (RIBS). We studied the mechanical and radiological properties of RIBS upon in vivo implantation in rats and we evaluated RIBS implantability in human anatomical specimens. For this purpose, a blend of PLA50-PEG-PLA50 triblock copolymer, used as a polymer matrix, and of X-ray-visible triiodobenzoate-poly(ε-caprolactone) copolymer (PCL-TIB), as a radiopaque additive, was used to design X-ray-visible RIBS. Samples were implanted in the peritoneal cavity of rats. The radiological, chemical, and biomechanical properties were evaluated during degradation. Further histological studies were carried out to evaluate the degradation and compatibility of the RIBS. A human cadaver implantability study was also performed. The in vivo results revealed a decline in the RIBS mechanical properties within 3 months, whereas clear and stable X-ray visualization of the RIBS was possible for up to 6 months. Histological analyses confirmed compatibility and resorption of the RIBS, with a limited inflammatory response. The RIBS could be successfully implanted in human anatomic specimens. The results reported in this study will allow the development of trackable and degradable IBS to reduce biliary complications after liver transplantation. STATEMENT OF SIGNIFICANCE: Biliary reconstruction during liver transplantation is an important source of postoperative morbidity and mortality although it is generally considered as an easy step of a difficult surgery. In this frame, internal biliary stent (IBS) implantation is beneficial to reduce biliary anastomosis complications (leakage, stricture). However, current IBS are made of non-degradable silicone elastomeric materials, which leads to an additional ablation procedure involving potential complications and additional costs. The present study provides in vitro and human postmortem implantation data related to the development and evaluation of a resorbable and radiopaque internal biliary stent (RIBS) that could tackle these drawbacks.
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Affiliation(s)
- Edouard Girard
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France; Département de chirurgie digestive et de l'urgence, Centre Hospitalier Grenoble-Alpes, 38000 Grenoble, France; Laboratoire d'anatomie des Alpes françaises (LADAF), UFR de médecine de Grenoble, Université de Grenoble-Alpes, F-38700 Grenoble, France.
| | - Grégory Chagnon
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France
| | - Alexis Broisat
- INSERM, Unité 1039, F-38000 Grenoble, France; Radiopharmaceutiques Biocliniques, Université Grenoble-Alpes, F-38000 Grenoble, France
| | - Stéphane Dejean
- IBMM, Université de Montpellier, CNRS, ENSCM, Montpellier, France
| | - Audrey Soubies
- INSERM, Unité 1039, F-38000 Grenoble, France; Radiopharmaceutiques Biocliniques, Université Grenoble-Alpes, F-38000 Grenoble, France
| | - Hugo Gil
- Département d'anatomopathologie et cytologie, Centre Hospitalier Grenoble-Alpes, 38000 Grenoble, France
| | - Tahmer Sharkawi
- ICGM, Université de Montpellier, CNRS, ENSCM, Montpellier, France
| | - François Boucher
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France; Radiopharmaceutiques Biocliniques, Université Grenoble-Alpes, F-38000 Grenoble, France
| | - Gaël S Roth
- Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309, Université Grenoble-Alpes, F-38700 Grenoble, France; Clinique universitaire d'Hépato-gastroentérologie et Oncologie digestive, CHU Grenoble-Alpes, Grenoble 38043, France
| | - Bertrand Trilling
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France; Département de chirurgie digestive et de l'urgence, Centre Hospitalier Grenoble-Alpes, 38000 Grenoble, France; Laboratoire d'anatomie des Alpes françaises (LADAF), UFR de médecine de Grenoble, Université de Grenoble-Alpes, F-38700 Grenoble, France
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A systematic review of biodegradable biliary stents: promising biocompatibility without stent removal. Eur J Gastroenterol Hepatol 2018; 30:813-818. [PMID: 29782386 DOI: 10.1097/meg.0000000000001167] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Biodegradable self-expanding stents are an emerging alternative to standard biliary stents as the development of endoscopic insertion devices advances. The aim was to systematically review the existing literature on biodegradable biliary stents. In-vivo studies on the use of biodegradable stents in the biliary duct were systematically reviewed from 1990 to 2017. Despite extensive research on the biocompatibility of stents, the experience so far on their clinical use is limited. A few favorable reports have recently been presented on endoscopically and percutaneously inserted self-expanding biodegradable polydioxanone stents in benign biliary strictures. Another potential indication appears to be postcholecystectomy leak of the cystic duct. The main benefit of biodegradable stents is that stent removal can be avoided. The biocompatibility of the current biodegradable stent materials, most prominently polydioxanone, is well documented. In the few studies currently available, biodegradable stents are reported to be feasible and safe, also in humans. The initial results of the endoscopic use of these stents in benign biliary stricture management and for treating postcholecystectomy bile leaks are promising. Further controlled studies on long-term clinical results and cost-effectiveness are needed.
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Dopazo C, Diez I, Quintero J, Curell A, González-Junyent C, Caralt M, Pando E, Lázaro JL, Molino JA, Juamperez J, Castells L, Pérez M, Bilbao I, Segarra A, Charco R. Role of Biodegradable Stents as Part of Treatment of Biliary Strictures after Pediatric and Adult Liver Transplantation: An Observational Single-Center Study. J Vasc Interv Radiol 2018; 29:899-904. [DOI: 10.1016/j.jvir.2018.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 12/15/2022] Open
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Hai R, Kuban J. Percutaneous intervention for bilioenteric anastomotic strictures: Current strategies and future directions. GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rayhan Hai
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joshua Kuban
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Gwon DI, Laasch HU. Radiological approach to benign biliary strictures. GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.1016/j.gii.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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