title: Time Sequence Evaluation of Biliary Stent Occlusion by Dissection Analysis of Retrieved Stents.
abstract: Multiple factors can affect the occlusion of plastic stents. Previous data demonstrate that side holes may induce more biofilm formation probably via microturbulence and bile flow disturbances that could lead to occlusion. These results, however, have not been replicated in subsequent clinical studies with different methods. The objective of this study is to evaluate the physical characteristics of plastic stent occlusion over time.
  
  
  
  This is a plastic stent sequential analysis study. Biliary stents removed via ERCP from February 24, 2015, to June 2, 2015, were included. One hundred and forty-eight retrieved straight-type plastic stents were longitudinally cut by a custom-made cutting device. These dissected stents were then evaluated in detail with regard to the location of stent occlusion and the stent patency period. Location of stent occlusive debris was the primary outcome in this study.
  
  
  
  Biofilm formations and occlusions by debris were sequentially but separately tallied. Biofilm formations were initially seen around the side hole areas within 30 days and spread to the entire stent by 60 days. Then, occlusion process by debris was mainly initiated by 80 days and progressed to full occlusion by median of 90 days. Although some occlusions were also observed around the side hole areas within 30 days, affected areas were more widely observed after biofilm formation.
  
  
  
  This study is the first to attempt to describe the distribution of stent occlusions over time. These observations may help guide future stent development.
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA.
authors.forename: Chang-Il
authors.initials: CI
authors.lastname: Kwon
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gromski
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Easler
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA.
authors.forename: Ihab I
authors.initials: II
authors.lastname: El Hajj
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA.
authors.forename: James
authors.initials: J
authors.lastname: Watkins
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA.
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Blvd., Suite 1634, Indianapolis, IN, 46202-5149, USA. glehman@iu.edu.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000601:surgery*; D018441:Biofilms; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000601:surgery*; D003251:Constriction, Pathologic; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010969:Plastics; D011475:Prosthesis Failure; D015607:Stents / Q000382:microbiology; D013997:Time Factors
chemical_list: D010969:Plastics
keywords: Biofilm; Debris; Duodenal reflux; Endoscopic retrograde cholangiopancreatography; Occlusion; Stents