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.
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.


METHODS
A newly designed antireflux PBS (AR-PBS) was tested in vitro by using ox bile. A prospective randomized trial in human beings was conducted.


METHODS
Tertiary medical center.


METHODS
Patients with malignant bile-duct strictures were studied.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Dua
Kulwinder S
KS
Pancreatico-biliary Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Reddy
Nageshwar D
ND
Rao
Venkat G
VG
Banerjee
Rupa
R
Medda
Bidyut
B
Lang
Ivan
I
D000818:Animals; D001655:Bile Reflux / Q000601:surgery*; D001659:Biliary Tract / Q000503:physiopathology; D002417:Cattle; D002779:Cholestasis / Q000601:surgery*; D003251:Constriction, Pathologic; D004322:Drainage / Q000295:instrumentation; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012212:Rheology; D015607:Stents / Q000009:adverse effects / Q000592:standards