Original ArticleDo Pancreatic Duct Stents Cause or Prevent Pancreatic Sepsis?
Section snippets
Patients and Methods
A retrospective study was conducted of 61 consecutive patients (29 men, 32 women; mean age 51 [16] years, range 14–88 years) between January and June of 2001. The study was approved by the institutional review board of our medical center. No patient who underwent endoscopic stent retrieval without ERCP was included. The 61 patients had 36 pancreatic and 36 biliary stents; 11 had stents in both ducts. The original indications for stent insertion are outlined in Table 1. In addition to the
Results
At the time of stent retrieval and/or exchange, all 61 patients with pancreaticobiliary stents had contamination of the respective ducts (Table 2). The mean number of organisms was 3.4 (range 2–6) in the PD and 3.3 (range 2–5) in the BD. Clostridium perfringens was found only in BD cultures (6/36 [17%] vs. 0/36; p = 0.025). However, comparisons were made between the BD and PD for all organisms (n = 20), and, because of this multiple comparison issue, the statistical significance for the
Discussion
Much has been written about cholangitis as a consequence of biliary stent occlusion. The latter is most commonly the consequence of bacterial biofilm development with subsequent biliary stasis and overgrowth of bacteria translocated from thegut.3, 4, 5, 7, 8, 9, 10 Gram-negative rods and gram-positive cocci predominate, both in the contaminated bile23 and within the lumen of the stent, although studies suggest that anaerobic bacteria may play a role related to early adherence to the stent.10
References (37)
- et al.
Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial
Gastrointest Endosc
(2002) - et al.
Is there a synergistic effect between mixed bacterial infection in biofilm formation in biliary stents?
Gastrointest Endosc
(1998) Preventing biliary stent occlusion
Gastrointest Endosc
(2000)- et al.
A scanning electron microscopic study of biliary stent materials
Gastrointest Endosc
(2000) - et al.
Early attachment of anaerobic bacteria may play an important role in biliary stent blockage
Gastrointest Endosc
(2000) - et al.
Surgical approach in patients with acute pancreatitis. Is infected or sterile necrosis an indication: in whom should this be done, when, and why?
Gastrointest Endosc Clin N Am.
(1999) - et al.
Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and “planned” reoperations
J Am Coll Surg
(1998) - et al.
Randomized trial of prevention of biliary stent occlusion by ursodeoxycholic acid plus norfloxacin
Lancet
(1994) - et al.
In vitro evaluation of antibiotic prophylaxis in the prevention of biliary stent blockage
Gastrointest Endosc
(2000) - et al.
A combination of ciprofloxacin and Rowachol does not prevent biliary stent occlusion
Gastrointest Endosc
(1999)
A placebo-controlled study on the efficacy of aspirin and doxycycline in preventing clogging of biliary endoprostheses
Gastrointest Endosc
Inhibition of biliary endoprostheses occlusion by ampicillin-sulbactam in an in vitro model
J Lab Clin Meth
Risk of contamination of sterile biopsy forceps in disinfected endoscopes
Gastrointest Endosc
Reusable biopsy forceps: a prospective evaluation of cleaning capabilities, function, adequacy of tissue specimen, and durability
Gastrointest Endosc
Reuse of disposable sphincterotomes for diagnostic and therapeutic ERCP: a one-year prospective study
Gastrointest Endosc
The occlusion rate of pancreatic stents
Gastrointest Endosc
Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis
Gastrointest Endosc
Characterization of the content of occluded biliary endoprostheses
Endoscopy
Cited by (44)
Preliminary study of a modified, nonflared, short, fully covered metal stent for refractory benign pancreatic duct strictures (with videos)
2020, Gastrointestinal EndoscopyCitation Excerpt :After stent removal, occurrence of a new pancreatic ductal stricture at the locations of the ends of the FCSEMS was defined as development of FCSEMS-related MPD stricture. Pancreatic sepsis was defined as clinical sepsis at the time of FCSEMS placement and retrieval.12 Other adverse events after ERCP were recorded according to the guidelines of the American Society for Gastrointestinal Endoscopy.13
Nonreplacement treatment of chronic pancreatitis: Conservative, endoscopic, and surgical (resection and drainage procedures)
2019, Transplantation, Bioengineering, and Regeneration of the Endocrine Pancreas: Volume 2Pancreatic Interventions in Acute Pancreatitis: Ascites, Fistulae, Leaks, and Other Disruptions
2018, ERCP, Third EditionEndoscopic Management of Acute Biliary Pancreatitis
2013, Gastrointestinal Endoscopy Clinics of North AmericaKey Points
2013, ERCP: Second Edition