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Histological Changes in the Bile Duct after Long-Term Placement of a Fully Covered Self-Expandable Metal Stent within a Common Bile Duct: A Canine Study.

Lee SS, Song TJ, Joo M, Park do H, Seo DW, Lee SK, Kim MH - Clin Endosc (2014)

Bottom Line: The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS.On histopathological examination, mild inflammatory changes were observed in the stented bile ducts, and there was no significant difference between the four groups.An FCSEMS can be inserted into the bile duct without severe histopathological changes up until 9 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: To date, it has been difficult to determine the optimal stenting duration of a fully covered self-expandable metal stent (FCSEMS) in a benign biliary stricture. The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS.

Methods: An FCSEMS was inserted into the common bile duct of 12 canines, and the animals were divided into four groups. Posteuthanasia, necropsy was performed to examine the histopathological changes in the bile ducts after 1, 3, 6, and 9 months.

Results: The results of necropsy showed that the covered membranes of the FCSEMSs were intact and easily removed from the bile ducts in 11 of the canines. Severe epithelial hyperplasia of the stented bile duct and epithelial ingrowth into the stent occurred in one animal (from the 3-month group). On histopathological examination, mild inflammatory changes were observed in the stented bile ducts, and there was no significant difference between the four groups. Among the 12 animals, five had de novo stricture.

Conclusions: An FCSEMS can be inserted into the bile duct without severe histopathological changes up until 9 months. However, a de novo stricture and severe epithelial hyperplasia relating to the stent insertion might occur.

No MeSH data available.


Related in: MedlinePlus

Stent deployment under fluoroscopic guidance. (A) Cholangiography of a normal canine bile duct. (B) Fluoroscopic image of a guidewire placed inside the bile duct. (C) The stent is placed above the papilla. (D) The stent is in place after withdrawal of the delivery catheter and guidewire.
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Figure 1: Stent deployment under fluoroscopic guidance. (A) Cholangiography of a normal canine bile duct. (B) Fluoroscopic image of a guidewire placed inside the bile duct. (C) The stent is placed above the papilla. (D) The stent is in place after withdrawal of the delivery catheter and guidewire.

Mentions: As biliary strictures in dogs are uncommon, we used a normal biliary model. Stents were placed using an oral transpapillary approach via a 3.8-mm endoscope (ED-3630T video duodenoscope; Pentax, Tokyo, Japan). When an endoscope was extended to the major duodenal papilla, the bile duct was cannulated with a catheter, and a cholangiogram was obtained. The diameter and length of the FCSEMS were 8 mm and 4 to 5 cm, respectively. An FCSEMS is made of nitinol wire and is fully covered on both sides with a silicone membrane. Stents were deployed over a guidewire under endoscopic and fluoroscopic guidance. They were positioned proximal to the papilla to prevent distal stent migration during the study, and the correct position was confirmed by fluoroscopy (Fig. 1).


Histological Changes in the Bile Duct after Long-Term Placement of a Fully Covered Self-Expandable Metal Stent within a Common Bile Duct: A Canine Study.

Lee SS, Song TJ, Joo M, Park do H, Seo DW, Lee SK, Kim MH - Clin Endosc (2014)

Stent deployment under fluoroscopic guidance. (A) Cholangiography of a normal canine bile duct. (B) Fluoroscopic image of a guidewire placed inside the bile duct. (C) The stent is placed above the papilla. (D) The stent is in place after withdrawal of the delivery catheter and guidewire.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928498&req=5

Figure 1: Stent deployment under fluoroscopic guidance. (A) Cholangiography of a normal canine bile duct. (B) Fluoroscopic image of a guidewire placed inside the bile duct. (C) The stent is placed above the papilla. (D) The stent is in place after withdrawal of the delivery catheter and guidewire.
Mentions: As biliary strictures in dogs are uncommon, we used a normal biliary model. Stents were placed using an oral transpapillary approach via a 3.8-mm endoscope (ED-3630T video duodenoscope; Pentax, Tokyo, Japan). When an endoscope was extended to the major duodenal papilla, the bile duct was cannulated with a catheter, and a cholangiogram was obtained. The diameter and length of the FCSEMS were 8 mm and 4 to 5 cm, respectively. An FCSEMS is made of nitinol wire and is fully covered on both sides with a silicone membrane. Stents were deployed over a guidewire under endoscopic and fluoroscopic guidance. They were positioned proximal to the papilla to prevent distal stent migration during the study, and the correct position was confirmed by fluoroscopy (Fig. 1).

Bottom Line: The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS.On histopathological examination, mild inflammatory changes were observed in the stented bile ducts, and there was no significant difference between the four groups.An FCSEMS can be inserted into the bile duct without severe histopathological changes up until 9 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: To date, it has been difficult to determine the optimal stenting duration of a fully covered self-expandable metal stent (FCSEMS) in a benign biliary stricture. The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS.

Methods: An FCSEMS was inserted into the common bile duct of 12 canines, and the animals were divided into four groups. Posteuthanasia, necropsy was performed to examine the histopathological changes in the bile ducts after 1, 3, 6, and 9 months.

Results: The results of necropsy showed that the covered membranes of the FCSEMSs were intact and easily removed from the bile ducts in 11 of the canines. Severe epithelial hyperplasia of the stented bile duct and epithelial ingrowth into the stent occurred in one animal (from the 3-month group). On histopathological examination, mild inflammatory changes were observed in the stented bile ducts, and there was no significant difference between the four groups. Among the 12 animals, five had de novo stricture.

Conclusions: An FCSEMS can be inserted into the bile duct without severe histopathological changes up until 9 months. However, a de novo stricture and severe epithelial hyperplasia relating to the stent insertion might occur.

No MeSH data available.


Related in: MedlinePlus