The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-0604
+8 800 101-59-87
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Shabunin A.V.

S.P. Botkin City Clinical Hospital, Moscow, Russia;
Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russia

Tavobilov M.M.

Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF;
Federal'nyĭ mediko-biologicheskiĭ tsentr im. A.I. Burnaziana FMBA Rossii, Moskva

Lebedev S.S.

Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia

Karpov A.A.

A.F. Tsyb Medical Radiology Research Center, Branch, National Medical Radiology Research Center, Ministry of Health of the Russian Federation, Obninsk, Russia

Mechanisms and prevention of biliary stent occlusion

Authors:

Shabunin A.V., Tavobilov M.M., Lebedev S.S., Karpov A.A.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2020;(5): 70‑75

DOI: 10.17116/hirurgia202005170

Views: 3653

Downloaded: 127

Download PDF (RU)
Contact the author
Table of contents

To cite this article:

Shabunin AV, Tavobilov MM, Lebedev SS, Karpov AA. Mechanisms and prevention of biliary stent occlusion. Pirogov Russian Journal of Surgery. 2020;(5):70‑75. (In Russ.)
https://doi.org/10.17116/hirurgia202005170

Подписка 2025 (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
Close metadata

One of significant achievements of modern endoscopy is development of retrograde biliary stenting for obstructive jaundice. This method ensured widespread application of endoscopic decompression in the treatment of patients with malignant biliary obstruction as preparation before radical surgery and final palliative care. Endoscopic retrograde transpapillary stenting firmly took its place together with antegrade and percutaneous stenting. There are certain advantages of this technique including minimally invasiveness and favorable quality of life. However, this approach is associated with some drawbacks associated with stent occlusion and difficult correction of this complication. The maximum diameter of the plastic stent (PS) is determined by the width of the working channel of the duodenoscope. In this regard, self-expandable metal stents (SEMS) were developed to increase the diameter of bile drainage channel. SEMS are associated with prolonged function. However, there is another problem. It is a germination of SEMS followed by impossible removal of the stent for its subsequent replacement. A further step in development of endoscopic biliary stents was the use of special SEMS coating to exclude tumor or granulation ingrowth. The problem of biliary stent occlusion remains relevant despite some improvement of stenting results. Mechanisms of occlusion of biliary stents and prevention of these events are discussed in this review.

Keywords:

malignant biliary obstruction
plastic stent
self-expandable metal stent (SEMS)

Authors:

Shabunin A.V.

S.P. Botkin City Clinical Hospital, Moscow, Russia;
Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russia

Tavobilov M.M.

Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF;
Federal'nyĭ mediko-biologicheskiĭ tsentr im. A.I. Burnaziana FMBA Rossii, Moskva

Lebedev S.S.

Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia

Karpov A.A.

A.F. Tsyb Medical Radiology Research Center, Branch, National Medical Radiology Research Center, Ministry of Health of the Russian Federation, Obninsk, Russia

List of references:

  1. Ballinger AB, McHugh M, Catnach SM, Alstead EM, Clark ML. Symptom relief and quality of life after stenting for malignant bile duct obstruction. . 1994;35:467-470.
  2. Faigel DO. Preventing biliary stent occlusion. . 2000;51:104-107.
  3. Raijman I. Biliary and pancreatic stents. . 2003;13:561-592.
  4. Hamada T, Isayama H, Nakai Y, et al. Antireflux Metal Stent as a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study. . 2017;11(1):142-148. 
  5. Isayama H, Komatsu Y, Tsujino T, et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. . 2002;55:366-370. 
  6. Jeong S. Basic Knowledge about Metal Stent Development. . 2016;49(2):108-112. 
  7. Soehendra N, Reynders-Frederix V. Palliative bile duct drainage: a new endoscopic method of introducing a transpapillary drain. . 1980;12:8-11.
  8. Speer AG, Cotton PB, Russell RC, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. . 1987;2:57-62.
  9. Libby ED, Leung JW. Prevention of biliary stent clogging: a clinical review. . 1996;91:1301-1308.
  10. Leung JW, Liu Y, Chan RC, et al. Early attachment of anaerobic bacteria may play an important role in biliary stent blockage. 2000;52:725-729.
  11. Van Berkel AM, van Marle J, Groen AK, Bruno MJ. Mechanisms of biliary stent clogging: confocal laser scanning and scanning electron microscopy. . 2005;37:729-734.
  12. Guaglianone E, Cardines R, Vuotto C, et al. Microbial biofilms associated with biliary stent clogging. . 2010;59:410-420.
  13. Groen AK, Out T, Huibregtse K, Delzenne B, Hoek FJ, Tytgat GN. Characterization of the content of occluded biliary endoprostheses. . 1987;19:57-59.
  14. Speer AG, Cotton PB, Rode J, et al. Biliary stent blockage with bacterial biofilm. A light and electron microscopy study. . 1988;108:546-553.
  15. Leung JW, Ling TK, Kung JL, Vallance-Owen J. The role of bacteria in the blockage of biliary stents. . 1988;34: 19-22.
  16. Moesch C, Sautereau D, Cessot F, et al. Physicochemical and bacteriological analysis of the contents of occluded biliary endoprostheses. . 1991;14:1142-1146.
  17. An YH, Friedman RJ. Concise review of mechanisms of bacterial adhesion to biomaterial surfaces. . 1998;43:338-348.
  18. Chan FK, Suen M, Li JY, Sung JJ. Bile immunoglobulins and blockage of biliary endoprosthesis: an immunohistochemical study. . 1998;52:403-407.
  19. Yu JL, Andersson R, Ljungh A. Protein adsorption and bacterial adhesion to biliary stent materials. . 1996;62:69-73.
  20. Yu JL, Andersson R, Wang LQ, Bengmark S, Ljungh A. Fibronectin on the surface of biliary drain materials: a role in bacterial adherence. . 1995;59:596-600.
  21. Kwon C-I, Gromski MA, Sherman S, Easler JJ, El Hajj II, Watkins J, Lehman GA. Time Sequence Evaluation of Biliary Stent Occlusion by Dissection Analysis of Retrieved Stents. . 2016;61(8):2426-2435.
  22. Vaishnavi C, Samanta J, Kochhar R. Characterization of biofilms in biliary stents and potential factors involved in occlusion. . 2018;24(1):112-123. 
  23. Jirapinyo P, AlSamman MA, Thompson CC. Impact of infected stent removal on recurrent cholangitis with time-to-event analysis. . 2019;33:4109-1115.
  24. Lübbert C, Wendt K, Feisthammel J, et al. Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study. . 2016;11(5):e0155479. Published 2016 May 25. 
  25. Donelli G, Guaglianone E, Di Rosa R, Fiocca F, Basoli A. Plastic biliary stent occlusion: factors involved and possible preventive approaches. . 2007;5:53-60.
  26. Speer AG, Cotton PB, MacRae KD. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. . 1988;34:412-417.
  27. ASGE Technology Assessment Committee, Pfau PR, Pleskow DK, et al. Pancreatic and biliary stents. . 2013;77:319-327.
  28. Gilbert DA, DiMarino AJ Jr, Jensen DM, et al. Status evaluation: biliary stents. American Society for Gastrointestinal Endoscopy. Technology Assessment Committee. . 1992;38:750-752.
  29. Kadakia SC, Starnes E. Comparison of 10 French gauge stent with 11.5 French gauge stent in patients with biliary tract diseases. . 1992;38:454-459.
  30. Wagh MS, de Bellis M, Fogel EL, et al. Multicenter randomized trial of 10-French versus 11.5-French plastic stents for malignant biliary obstruction. . 2013;2013:891915.
  31. Kawashima H, Hashimoto S, Ohno E, Ishikawa T, Morishima T, Matsubara H. Comparison of 8-mm and 10-mm Diameter Fully- Covered Self-Expandable Metal Stents: A Multicenter Prospective Study in Patients with Distal Malignant Biliary Obstruction. . 2019.
  32. Shabunin AV, Tavobilov MM, Lebedev SS, Korzheva IYu, Karpov AA, Lantsynova AV, Kochubej VV. Sravnitel’nyj analiz endoskopicheskogo stentirovaniya polnost’yu pokrytymi samorasshiryayushchimisya stentami u patsientov s nerezektabel’noj distal’noj biliarnoj obstruktsiej. . 2019;4:60-64.
  33. Van Berkel AM, Boland C, Redekop WK, et al. A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction. . 1998;30:681-686.
  34. England RE, Martin DF, Morris J, et al. A prospective randomised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton-Leung stents in patients with malignant common duct strictures. . 2000;46:395-400.
  35. Terruzzi V, Comin U, De Grazia F, et al. Prospective randomized trial comparing Tannenbaum Teflon and standard polyethylene stents in distal malignant biliary stenosis. . 2000;51:23-27.
  36. Cheon YK, Oh HC, Cho YD, Lee TY, Shim CS. New 10F soft and pliable polyurethane stents decrease the migration rate compared with conventional 10F polyethylene stents in hilar biliary obstruction: results of a pilot study. . 2012;75:790-797.
  37. Sasahira N, Hamada T, Togawa O, et al. Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction. . 2016;22(14):3793-3802.
  38. Motte S, Deviere J, Dumonceau JM, Serruys E, Thys JP, Cremer M. Risk factors for septicemia following endoscopic biliary stenting. . 1991;101:1374-1381.
  39. Shepherd HA, Royle G, Ross AP, Diba A, Arthur M, Colin-Jones D. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. . 1988;75:1166-1168.
  40. Schmassmann A, von Gunten E, Knuchel J, Scheurer U, Fehr HF, Halter F. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. . 1996;91:654-659.
  41. Kwon CI, Ko KH, Hahm KB, Kang DH. Functional self-expandable metal stents in biliary obstruction. . 2013;46:515-521.
  42. Galandi D, Schwarzer G, Bassler D, Allgaier HP. Ursodeoxycholic acid and/or antibiotics for prevention of biliary stent occlusion. . 2002;(3):CD003043.
  43. Jang S, Stevens T, Parsi MA, Lopez R & Vargo JJ. Aspirin Use Is Associated With Reduced Risk of Occlusion of Metallic Biliary Stents. . 2017;15(3):446-453.
  44. Browne S, Schmalz M, Geenen J, Venu R, Johnson GK. A comparison of biliary and pancreatic stent occlusion in antibiotic-coated vs. conventional stents. . 1990;36:206.
  45. Gwon DI, Lee SS, Kim EY. Cefotaxime-eluting covered self-expandable stents in a canine biliary model: scanning electron microscopic study of biofilm formation. . 2012;53:1127-1132.
  46. Weickert U, Wiesend F, Subkowski T, Eickhoff A, Reiss G. Optimizing biliary stent patency by coating with hydrophobin alone or hydrophobin and antibiotics or heparin: an in vitro proof of principle study. . 2011;56:138-144.
  47. Dowidar N, Kolmos HJ, Matzen P. Experimental clogging of biliary endoprostheses. Role of bacteria, endoprosthesis material, and design. 1992;27:77-80.
  48. Jansen B, Goodman LP, Ruiten D. Bacterial adherence to hydrophilic polymer-coated polyurethane stents. 1993;39: 670-673.
  49. Sung JY, Shaffer EA, Lam K, Rususka I, Costerton JW. Hydrophobic bile salt inhibits bacterial adhesion on biliary stent material. 1994;39:999-1006.
  50. John SF, Hillier VF, Handley PS, Derrick MR. Adhesion of staphylococci to polyurethane and hydrogel-coated polyurethane catheters assayed by an improved radiolabelling technique. 1995;43:133-140.
  51. McAllister EW, Carey LC, Brady PG, Heller R, Kovacs SG. The role of polymeric surface smoothness of biliary stents in bacterial adherence, biofilm deposition, and stent occlusion. 1993;39: 422-425.
  52. Hoffman BJ, Cunningham JT, Marsh WH, O’Brien JJ, Watson J. An in vitro comparison of biofilm formation on various biliary stent materials. 1994;40:581-583.
  53. Van Berkel AM, Bruno MJ, Bergman JJ, van Deventer SJ, Tytgat GN, Huibregtse K. A prospective randomized study of hydrophilic polymer-coated polyurethane versus polyethylene stents in distal malignant biliary obstruction. . 2003;35:478-482.
  54. Costamagna G, Mutignani M, Rotondano G, et al. Hydrophilic hydromer-coated polyurethane stents versus uncoated stents in malignant biliary obstruction: a randomized trial. . 2000;51:8-11.
  55. Yang J, Linghu E, Wang Y. Development of antibacterial plastic biliary stent coated with nano-silver. 2011;35: 352-355, 360.
  56. Wen W, Ma L-M, He W, Tang X-W, Zhang Y, Wang X, Fan Z-N. Silver-nanoparticle-coated biliary stent inhibits bacterial adhesion in bacterial cholangitis in swine. . 2016;15(1):87-92.
  57. Weickert U, Weddeling S, Subkowski T, Eickhoff A, Reiss G. Improving biliary stent patency by the use of stent coating — a prospective randomized porcine study. 2016;54(07): 629-633. 
  58. Lee TH, Jung MK, Kim TK, Pack CG, Park YK, Kim SO, Park DH. Safety and efficacy of a metal stent covered with a silicone membrane containing integrated silver particles in preventing biofilm and sludge formation in endoscopic drainage of malignant biliary obstruction: a phase 2 pilot study. 2019 Oct;90(4):663-672.e2. 
  59. Yamabe A, Irisawa A, Wada I, et al. Application of a silver coating on plastic biliary stents to prevent biofilm formation: an experimental study using electron microscopy. 2016;4(10):E1090-E1095.
  60. Coene PP, Groen AK, Cheng J, Out MM, Tytgat GN, Huibregtse K. Clogging of biliary endoprostheses: a new perspective. . 1990;31:913-917.
  61. Rey JF, Maupetit P, Greff M. Experimental study of biliary endoprosthesis efficiency. . 1985;17:145-148.
  62. Seitz U, Vadeyar H, Soehendra N. Prolonged patency with a new-design Teflon biliary prosthesis. . 1994;26:478-482.
  63. Park JS, Jeong S, Lee DH, Moon JH, Lee KT, Dong SH. A Double-Layered Covered Biliary Metal Stent for the Management of Unresectable Malignant Biliary Obstruction: A Multicenter Feasibility Study. 2016;10(6):969-974. 
  64. 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. . 2007;65:819-828.
  65. Leong QW, Shen ML, Au KW, et al. A prospective, randomized study of the patency period of the plastic antireflux biliary stent: an interim analysis. . 2016;83:387-393.
  66. Lee YN, Moon JH, Choi HJ, et al. Effectiveness of a newly designed antireflux valve metal stent to reduce duodenobiliary reflux in patients with unresectable distal malignant biliary obstruction: a randomized, controlled pilot study (with videos). . 2016;83:404-412.
  67. Hu B, Wang TT, Wu J, Shi ZM, Gao DJ, Pan YM. Antireflux stents to reduce the risk of cholangitis in patients with malignant biliary strictures: a randomized trial. . 2014;46:120-126.
  68. Kim DU, Kwon CI, Kang DH, Ko KH, Hong SP. New antireflux self-expandable metal stent for malignant lower biliary obstruction: in vitro and in vivo preliminary study. . 2013;25:60-66.
  69. Hamada T, Isayama H, Nakai Y, et al. Antireflux Metal Stent as a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study. 2017;11(1):142-148. 
  70. Georghegan JG, Branch MS, Costerton JW, Pappas TN, Cotton PB. Placement of biliary stents above the sphincter of Oddi prolongs stent patency in dogs. . 1991;32:A1232.
  71. Pedersen FM, Lassen AT, Schaffalitzky de Muckadell OB. Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction. . 1998;48:574-579.
  72. Ishiwatari H, Hayashi T, Ono M, Sato T, Kato J. Newly designed plastic stent for endoscopic placement above the sphincter of Oddi in patients with malignant hilar biliary obstruction. . 2013;25:94-99. 
  73. Inatomi O, Bamba S, Shioya M, et al. Threaded biliary inside stents are a safe and effective therapeutic option in cases of malignant hilar obstruction. . 2013;13:31. Published 2013 Feb 14. 
  74. Jo J-H, Park B-H. Suprapapillary versus Transpapillary Stent Placement for Malignant Biliary Obstruction: Which Is Better? 2015;26(4):573-582. 
  75. Shin J, Park J-S, Jeong S, Lee DH. Comparison of the Clinical Outcomes of Suprapapillary and Transpapillary Stent Insertion in Unresectable Cholangiocarcinoma with Biliary Obstruction. 2020;65:1231-1238. Published 2019 Oct 04. 

Close metadata

Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.