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Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model.

Bakhru MR, Foley PL, Gatesman J, Schmitt T, Moskaluk CA, Kahaleh M - BMC Gastroenterol (2011)

Bottom Line: No severe inflammatory or fibrotic duct injury was observed in any of the study animals, with degree of injury graded as mild to moderate.FCSEMS appear to induce minimal tissue overgrowth or fibrosis post placement.Ease of removability and no significant histologic injury are advantages noted with FCSEMS., however, further studies are needed to evaluate treating benign biliary strictures with FCSEMS in humans.

View Article: PubMed Central - HTML - PubMed

Affiliation: Digestive Health, University of Virginia, Charlottesville, VA, USA.

ABSTRACT

Background: Fully covered Self-Expanding metal stents (FCSEMS) have been shown efficacious in palliating malignant biliary obstructions. There is little data analyzing mucosal response to their temporary placement in the bile duct.

Methods: Ten mini pigs underwent endoscopic placement of a FCSEMS (Wallflex, Boston Scientific). FCSEMS were kept in place for three months. At the end of the 3 months, FCSEMS were removed endoscopically. Five pigs were euthanized and their bile ducts harvested. The other five were kept alive for another month post removal. A single pathologist, created a scoring system (to determine degree of inflammation, fibrosis, and epithelial injury), examined all specimens in a blinded fashion.

Results: Four FCSEMS spontaneously migrated in the duodenum. On post mortem examination, mild mucosal thickness was noted in three bile duct specimens while superficial inflammation of the bile duct was noted in five animals. Histologic examination of the bile duct revealed focal acute inflammation in both groups. For the 5 animals euthanized immediately after stent removal, there was a tendency to have superficial mucosal erosion and fibrosis. In contrast, increased chronic inflammation was more commonly seen in the animals 1 month post stent removal, with all animals in this group showing moderate degrees of mononuclear inflammatory cell mucosal infiltrates. No severe inflammatory or fibrotic duct injury was observed in any of the study animals, with degree of injury graded as mild to moderate.

Conclusion: FCSEMS appear to induce minimal tissue overgrowth or fibrosis post placement. Ease of removability and no significant histologic injury are advantages noted with FCSEMS., however, further studies are needed to evaluate treating benign biliary strictures with FCSEMS in humans.

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Ercp Images for Stent Placment and Removal. 1A: Endoscopic Retrograde Cholangiography prior to Fcsems Placement 1B: Fluoroscopy Showing Complete Biliary Decompression after Fcsems Placement 1C: Rat Tooth Removal of the Fcsems 1D: Endoscopic Retrograde Cholangiography after Fcsems Removal
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Figure 1: Ercp Images for Stent Placment and Removal. 1A: Endoscopic Retrograde Cholangiography prior to Fcsems Placement 1B: Fluoroscopy Showing Complete Biliary Decompression after Fcsems Placement 1C: Rat Tooth Removal of the Fcsems 1D: Endoscopic Retrograde Cholangiography after Fcsems Removal

Mentions: A Fuji duodenoscope (ED-250XT5, Fujinon) was used for all endoscopic procedures. Endoscopic Retrograde Cholangiography using standard technique was performed using a triple lumen sphincterotome from Boston Scientific (Ultratome, Natick, MA) by a single endoscopist performing more than 500 ERCPs annually (MK). The bile duct anatomy was delineated under fluoroscopy (Figure 1A), and wire advanced into the biliary tree. The FCSEMS (Diameter of 8 or 10 mm) (Wallflex, Boston Scientific) was deployed under fluoroscopy and endoscopic visualization to confirm good decompression (Figure 1B).


Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model.

Bakhru MR, Foley PL, Gatesman J, Schmitt T, Moskaluk CA, Kahaleh M - BMC Gastroenterol (2011)

Ercp Images for Stent Placment and Removal. 1A: Endoscopic Retrograde Cholangiography prior to Fcsems Placement 1B: Fluoroscopy Showing Complete Biliary Decompression after Fcsems Placement 1C: Rat Tooth Removal of the Fcsems 1D: Endoscopic Retrograde Cholangiography after Fcsems Removal
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3142530&req=5

Figure 1: Ercp Images for Stent Placment and Removal. 1A: Endoscopic Retrograde Cholangiography prior to Fcsems Placement 1B: Fluoroscopy Showing Complete Biliary Decompression after Fcsems Placement 1C: Rat Tooth Removal of the Fcsems 1D: Endoscopic Retrograde Cholangiography after Fcsems Removal
Mentions: A Fuji duodenoscope (ED-250XT5, Fujinon) was used for all endoscopic procedures. Endoscopic Retrograde Cholangiography using standard technique was performed using a triple lumen sphincterotome from Boston Scientific (Ultratome, Natick, MA) by a single endoscopist performing more than 500 ERCPs annually (MK). The bile duct anatomy was delineated under fluoroscopy (Figure 1A), and wire advanced into the biliary tree. The FCSEMS (Diameter of 8 or 10 mm) (Wallflex, Boston Scientific) was deployed under fluoroscopy and endoscopic visualization to confirm good decompression (Figure 1B).

Bottom Line: No severe inflammatory or fibrotic duct injury was observed in any of the study animals, with degree of injury graded as mild to moderate.FCSEMS appear to induce minimal tissue overgrowth or fibrosis post placement.Ease of removability and no significant histologic injury are advantages noted with FCSEMS., however, further studies are needed to evaluate treating benign biliary strictures with FCSEMS in humans.

View Article: PubMed Central - HTML - PubMed

Affiliation: Digestive Health, University of Virginia, Charlottesville, VA, USA.

ABSTRACT

Background: Fully covered Self-Expanding metal stents (FCSEMS) have been shown efficacious in palliating malignant biliary obstructions. There is little data analyzing mucosal response to their temporary placement in the bile duct.

Methods: Ten mini pigs underwent endoscopic placement of a FCSEMS (Wallflex, Boston Scientific). FCSEMS were kept in place for three months. At the end of the 3 months, FCSEMS were removed endoscopically. Five pigs were euthanized and their bile ducts harvested. The other five were kept alive for another month post removal. A single pathologist, created a scoring system (to determine degree of inflammation, fibrosis, and epithelial injury), examined all specimens in a blinded fashion.

Results: Four FCSEMS spontaneously migrated in the duodenum. On post mortem examination, mild mucosal thickness was noted in three bile duct specimens while superficial inflammation of the bile duct was noted in five animals. Histologic examination of the bile duct revealed focal acute inflammation in both groups. For the 5 animals euthanized immediately after stent removal, there was a tendency to have superficial mucosal erosion and fibrosis. In contrast, increased chronic inflammation was more commonly seen in the animals 1 month post stent removal, with all animals in this group showing moderate degrees of mononuclear inflammatory cell mucosal infiltrates. No severe inflammatory or fibrotic duct injury was observed in any of the study animals, with degree of injury graded as mild to moderate.

Conclusion: FCSEMS appear to induce minimal tissue overgrowth or fibrosis post placement. Ease of removability and no significant histologic injury are advantages noted with FCSEMS., however, further studies are needed to evaluate treating benign biliary strictures with FCSEMS in humans.

Show MeSH
Related in: MedlinePlus