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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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Related in: MedlinePlus

Macroscopic examination of the bile duct showing superficial inflammation.
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Figure 2: Macroscopic examination of the bile duct showing superficial inflammation.

Mentions: Five of the 10 animals were euthanized (Euthanasia Solution 5 gr/ml 1 cc/10 lbs) and their bile duct harvested for histologic examination. The bile duct was removed from the hepatic bifurcation to the duodenum, including a portion of duodenum and the ampulla. The duct was then opened longitudinally and examined for damage and tissue response (Figure 2). The ducts were then preserved in formalin and sent histological analysis.


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)

Macroscopic examination of the bile duct showing superficial inflammation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Macroscopic examination of the bile duct showing superficial inflammation.
Mentions: Five of the 10 animals were euthanized (Euthanasia Solution 5 gr/ml 1 cc/10 lbs) and their bile duct harvested for histologic examination. The bile duct was removed from the hepatic bifurcation to the duodenum, including a portion of duodenum and the ampulla. The duct was then opened longitudinally and examined for damage and tissue response (Figure 2). The ducts were then preserved in formalin and sent histological analysis.

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