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- pancreaticobiliary biofilm
- cholangitis
- cholecystitis
- choledocholithiasis
- common bile duct stones
- gall stones
- pancreatic stent
Cholesterol stone formation may be a physiological response to limit bacterial biofilm development in bile. Its incorporation into plastic polymers may be a novel way to prevent biofilm development and subsequent stent occlusion in patients with biliary prostheses
Bacteria in the biliary tree have been the bane of surgeons and gastroenterologists alike. On the one hand, up to 50% of patients with chronic cholecystitis have positive bile cultures, as do 75% of patients with acute cholecystitis, and virtually 100% of individuals with cholangitis.1,2 On the other hand, gut flora are thought to play a key role in the formation of at least black pigment and mixed gall stones, by virtue of mucus production, and the elaboration of B-glucuronidase that deconjugates bilirubin leading to its precipitation with calcium and palmitate.3–7 Moreover, in the form of a biofilm in which bacteria deposit themselves in complex patterns within a mucopolysaccharide or glycocalyx infrastructure, their presence has been associated with progressive occlusion of implanted medical devices which have a lumen and infections resistant to conventional courses of antibiotics.8 Plastic biliary stents, most often placed for malignant obstructive jaundice, have also been noted to occlude by virtue of biofilm development.9,10 This biofilm appears to be multidimensional and consists of slime, immunoglobulins, and other proteins in conjunction with multiple bacteria species in the setting …