title: Does heparin coating reduce encrustation of biliary plastic endoprostheses? A prospective randomized trial.
abstract: OBJECTIVE
  Common bile duct stenting is widely performed for bridging benign and malignant obstructions. A major limitation is early stent occlusion making regular stent exchange necessary. Covalent binding of glycosaminoglycanes to polyethylene stents proved to reduce encrustation in urological implants. Since development of urological and biliary stent occlusion shows parallels, the aim of the study was to evaluate the efficacy of heparin coating of biliary endoprostheses in preventing encrustation.
  
  
  METHODS
  In a prospective randomized trial, heparin-coated and native stents were endoscopically placed for almost 90 days on average. After removal, all stents were dried (50°C, 24 h), weighed and after longitudinal incision visible encrustation and discoloration recorded. Fifty-three patients (21 females/32 males, 70 ± 12 (42-87) years) were included; 13 patients (4 females/9 males, 58-79 years) completed the study according to the protocol.
  
  
  RESULTS
  After removal, mean weight of encrustation in native stents was more than double as high as of covered stents (native: 37.9 ± 19.8 (16-93) mg; covered: 17.6 ± 6.7 (9-33) mg). In 12 of 13 cases, the encrustation weight of the native stent was higher than that of the corresponding covered stent in the same patient. Premature stent explantation became necessary in 3 of 13 native stents, because of recurrent jaundice or cholangitis but only in 1 of 13 covered stents. After longitudinal incision, the three uncovered stents showed excessive encrustation whereas no significant encrustation was found in the covered prosthesis. Altogether, covered stents showed less visible accumulation of clogging material and discoloration than native stents.
  
  
  CONCLUSIONS
  Covalent bound heparin is highly effective in preventing encrustation of biliary polyethylene endoprostheses.
authors.affiliation: Department of Medicine 2, Teaching Hospital Klinikum Fuerth, Friedrich-Alexander University Erlangen-Nuremberg, Jakob-Henle-Strasse 1, Fuerth, Germany. michael.farnbacher@klinikum-fuerth.de
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Farnbacher
authors.forename: Roland
authors.initials: R
authors.lastname: Lederer
authors.forename: Andreas
authors.initials: A
authors.lastname: Blana
authors.forename: H Thomas
authors.initials: HT
authors.lastname: Schneider
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000494:pharmacology; D002779:Cholestasis / Q000503:physiopathology / Q000601:surgery*; D003135:Common Bile Duct / Q000503:physiopathology / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design / Q000379:methods; D005260:Female; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008422:Materials Testing / Q000379:methods*; D008875:Middle Aged; D020959:Polyethylene / Q000627:therapeutic use; D011475:Prosthesis Failure; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D020959:Polyethylene; D006493:Heparin