Plastic biliary stent occlusion: factors involved and possible preventive approaches

Abstract

Endoscopic biliary stenting is today the most common palliative treatment for patients suffering from obstructive jaundice associated with malignant hepatobiliary tumors or benign strictures. However, recurrent jaundice, with or without cholangitis, is a major complication of a biliary endoprosthesis insertion. Thus, stent removal and replacement with a new one frequently occurs as a consequence of device blockage caused by microbial biofilm growth and biliary sludge accumulation in the lumen. Factors and mechanisms involved in plastic stent clogging arising from epidemiological, clinical and experimental data, as well as the possible strategies to prevent biliary stent failure, will be reviewed and discussed.

Figure 1.

Scanning electron micrographs of clogged polyethylene stents showing (a) fragments of a protein conditioning film layered on the inner surface of a blocked stent, as visible after removal of the sludge material, (b) different bacterial and fungal species colonizing the inner surface of the stent, (c) a mature biofilm of Enterococcus spp., (d) a Candida spp. mature biofilm exhibiting different stages of fungal growth, (e) typical flock-shaped cholesterol crystals, as well as numerous bacilli and (f) plant fibers found in the biliary sludge.