Original ArticlesEarly attachment of anaerobic bacteria may play an important role in biliary stent blockage☆,☆☆,★
Section snippets
Stents
Eighteen biliary stents were removed from 17 patients who had undergone endoscopic stent insertion between January and October 1998. The mean age of the patients was 50 years and the ratio of men to women was 1.3:1. The indications for biliary stent insertion are given in Table 1.
Benign causes 14 Bile leak 8 Pancreatitis 2 Papillary stenosis 1 Bile duct stone 2 Primary sclerosing cholangitis 1 Malignant causes 4 Gallbladder cancer 1 Pancreatic cancer 3
Results
All stents were patent with only 6 of 18 stents containing small deposits of sludge. Sixteen aerobic bacteria were isolated, viz, Enterococcus sp 8, Bacillus sp 3, Staphylococcus sp 2, Aspergillus sp 2 and Candida sp 1, but there were no E coli or Klebsiella sp identified among the recovered bacteria (Table 2).
Aerobic bacteria 16 Gram-positive bacteria 16 Enterococcus 8 Bacillus 3 Staphylococcus 2 Aspergillus 2 Candida 1 Gram-negative bacteria 0 Anaerobic
Discussion
Bacterial infection plays a significant role in the biliary sludge formation that predisposes to stent blockage. Different bacteria have been isolated from biliary sludge, the most common being the gram-negative E coli and Klebsiella sp and the gram-positive Enterococcus sp.10, 18 However in this study, E coli and the other gram-negative enteric bacteria were absent in the unblocked stents. All of the 18 patients had received a short course of antibiotic(s) immediately before or after stent
References (27)
- et al.
A placebo-controlled study on the efficacy of aspirin and doxycycline in preventing clogging of biliary endoprostheses
Gastrointest Endosc
(1989) - et al.
A combination of ciprofloxacin and rowachol does not prevent biliary stent occlusion
Gastrointest Endosc
(1999) - et al.
Antibiotics, biliary sepsis and bile duct stones
Gastrointest Endosc
(1994) - et al.
In vitro evaluation of antibiotic prophylaxis in the prevention of biliary stent blockage
- et al.
Randomised trial of prevention of biliary stent occlusion by ursodeoxycholic acid plus norfloxacin
Lancet
(1994) - et al.
Polyethylene stent blockage: a porcine model
Gastrointest Endosc
(2000) - et al.
Endoscopic stenting for palliation of malignant biliary obstruction
Dig Dis Sci
(1995) - et al.
Clogging and other complications of biliary endoprostheses
Scand J Gastroenterol
(1991) - et al.
Biliary stent blockage with bacterial biofilm
Ann Intern Med
(1988) - et al.
Prevention of biliary stent clogging: a clinical review
Clogging of biliary endoprostheses: a morphologic and bacteriologic study
Scand J Gastroenterol
Bacterial biofilm, brown pigment stone and blockage of biliary stents
J Gastroenterol Hepatol
Prevention of biliary stent occlusion using cyclical antibiotics and ursodeoxycholic acid
Gut
Cited by (0)
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J.W.L. is supported by VA Merit Review Grant #94-07-003.
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Reprint requests: Joseph Leung, MD, Division of Gastroenterology, PSSB, Ste 3500, 4150 V St., UC Davis Medical Center, Sacramento, CA 95817.
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Gastrointest Endosc 2000;52:725-9