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Peng T, Zhou C, Zhang Z, Liu Y, Lin X, Ye Y, Zhong Y, Wang P, Jia Y. Review on bile dynamics and microfluidic-based component detection: Advancing the understanding of bilestone pathogenesis in the biliary tract. BIOMICROFLUIDICS 2024; 18:014105. [PMID: 38370511 PMCID: PMC10869170 DOI: 10.1063/5.0186602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024]
Abstract
Bilestones are solid masses found in the gallbladder or biliary tract, which block the normal bile flow and eventually result in severe life-threatening complications. Studies have shown that bilestone formation may be related to bile flow dynamics and the concentration level of bile components. The bile flow dynamics in the biliary tract play a critical role in disclosing the mechanism of bile stasis and transportation. The concentration of bile composition is closely associated with processes such as nucleation and crystallization. Recently, microfluidic-based biosensors have been favored for multiple advantages over traditional benchtop detection assays for their less sample consumption, portability, low cost, and high sensitivity for real-time detection. Here, we reviewed the developments in bile dynamics study and microfluidics-based bile component detection methods. These studies may provide valuable insights into the bilestone formation mechanisms and better treatment, alongside our opinions on the future development of in vitro lithotriptic drug screening of bilestones and bile characterization tests.
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Affiliation(s)
- Tao Peng
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Chenxiao Zhou
- Li Po Chun United World College of Hong Kong, Hong Kong, China
| | | | | | - Xiaodong Lin
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Yongqing Ye
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunlong Zhong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ping Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanwei Jia
- Authors to whom correspondence should be addressed: and
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Huang H, Zhang B, Zhong J, Han G, Zhang J, Zhou H, Mao T, Liu Y. The behavior between fluid and structure from coupling system of bile, bile duct, and polydioxanone biliary stent: A numerical method. Med Eng Phys 2023; 113:103966. [PMID: 36966001 DOI: 10.1016/j.medengphy.2023.103966] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
The performance and effects of 12 different structures of stents in the bile duct were compared and used the finite element method. Numerical models of the 12 kinds of fluid-structure interaction(FSI) coupling systems were established to investigate the relationship between three aspects (velocity distribution of bile, wall shear stress (WSS) distribution of bile, and Von Mises Stress(VMS) distribution on the stent and bile duct) and the structural parameters of the stent (monofilament diameter and the number of braiding heads). After calculating and analyzing the simulation results yielding distributions of velocity, WWS, and VMS and regions of bile duct susceptibility to stenosis, they were consistent with previous findings on the locations of restenosis occurring after stent removal, indicating that the simulation results could provide a useful reference for studying biliary stents. The results of the simulations showed that (i) eddy currents were prone to occur at the stent ends regions; (ii) the WSS distribution of the bile fluid in contact with the stent and bile duct related to the stent structure; (iii) the high VMS on the stent and bile duct was prone to occur at the stent ends. The simulation results of 12 FSI coupling systems were studied and two superior stent model structures were obtained by comprehensive evaluation.
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Affiliation(s)
- Huicheng Huang
- College of Textiles and Clothing, State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, Shandong, 266000, China
| | - Bin Zhang
- College of Textiles and Clothing, State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, Shandong, 266000, China
| | - Jun Zhong
- LONG RUN TEXTILECO.,LTD, Zaozhuang, Shandong, 277110, China
| | - Guangting Han
- College of Textiles and Clothing, State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, Shandong, 266000, China
| | - Jiawei Zhang
- College of Textiles and Clothing, State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, Shandong, 266000, China
| | - Hao Zhou
- College of Textiles and Clothing, State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, Shandong, 266000, China
| | - Tao Mao
- Department of gastroenterology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China
| | - Yanhui Liu
- College of Textiles and Clothing, State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao, Shandong, 266000, China.
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Su Y, Xiang Z, Song X, Zheng S, Xu X. Design and Optimization of a New Anti-reflux Biliary Stent With Retractable Bionic Valve Based on Fluid-Structure Interaction Analysis. Front Bioeng Biotechnol 2022; 10:824207. [PMID: 35419358 PMCID: PMC8995556 DOI: 10.3389/fbioe.2022.824207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Duodenal biliary reflux has been a challenging common problem which could cause dreadful complications after biliary stent implantation. A novel anti-reflux biliary stent with a retractable bionic valve was proposed according to the concertina motion characteristics of annelids. A 2D equivalent fluid-structure interaction (FSI) model based on the axial section was established to analyze and evaluate the mechanical performances of the anti-reflux biliary stent. Based on this model, four key parameters (initial shear modulus of material, thickness, pitch, and width) were selected to investigate the influence of design parameters on anti-reflux performance via an orthogonal design to optimize the stent. The results of FSI analysis showed that the retrograde closure ratio of the retractable valve primarily depended on initial shear modulus of material (p < 0.05) but not mainly depended on the thickness, pitch, and width of the valve (p > 0.05). The optimal structure of the valve was finally proposed with a high retrograde closing ratio of 95.89%. The finite element model revealed that the optimized anti-reflux stent possessed improved radial mechanical performance and nearly equal flexibility compared with the ordinary stent without a valve. Both the FSI model and experimental measurement indicated that the newly designed stent had superior anti-reflux performance, effectively preventing the duodenobiliary reflux while enabling the bile to pass smoothly. In addition, the developed 2D equivalent FSI model provides tremendous significance for resolving the fluid-structure coupled problem of evolution solid with large deformation and markedly shortens the calculation time.
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Affiliation(s)
- Yushan Su
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Zhongxia Xiang
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Xiaofei Song
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Shuxian Zheng
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
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Kuchumov AG, Vedeneev V, Samartsev V, Khairulin A, Ivanov O. Patient-specific fluid-structure interaction model of bile flow: comparison between 1-way and 2-way algorithms. Comput Methods Biomech Biomed Engin 2021; 24:1693-1717. [PMID: 34176396 DOI: 10.1080/10255842.2021.1910942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Gallbladder disease is one of the most spread pathologies in the world. Despite the number of operations dealing with biliary surgery increases, the number of postoperative complications is also high. The aim of this study is to show the influence of the biliary system pathology on bile flow character and to numerically assess the effect of surgical operation (cholecystectomy) on the fluid dynamics in the extrahepatic biliary tree, and also to reveal the difference between 1-way and 2-way FSI algorithms on the results. Moreover, the bile viscosity and biliary tree geometry influence on the choledynamics were evaluated. Bile velocity, pressure, wall shear stress (WSS), displacements and von Mises stress distributions in the extrahepatic biliary tree are presented, and comparison is made between a healthy and a lithogenic bile. The patient-specific biliary tree model is created using magnetic resonance imaging (MRI) and imported in a commercial finite element analysis software. It is found that in the case of lithogenic bile, velocities have lower magnitude while pressures are higher. Furthermore, stress analysis of the bile ducts shows that the WSS distribution is found mostly prevailing in the common hepatic duct and common bile duct areas. It is shown that when it is necessary to evaluate the bile flow dynamics in urgent medical situations, 1-way analysis is acceptable. Nevertheless, 2-way FSI provides more accurate data, if necessary to evaluate the stress-strain state of bile ducts. The proposed model can be applied to medical practice to reduce the number of post-operative complications.
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Affiliation(s)
- Alex G Kuchumov
- Department of Computational Mathematics, Mechanics, and Biomechanics, Perm National Research Polytechnic University, Perm, Russian Federation.,Mathematical Center, Kazan Federal University, Kazan, Russian Federation
| | - Vasily Vedeneev
- Steklov Mathematical Institute of Russian Academy of Sciences, Moscow, Russian Federation.,Institute of Mechanics, Moscow, Russian Federation
| | - Vladimir Samartsev
- Department of General Surgery, Perm State Medical University, Perm, Russian Federation
| | - Aleksandr Khairulin
- Department of Computational Mathematics, Mechanics, and Biomechanics, Perm National Research Polytechnic University, Perm, Russian Federation
| | - Oleg Ivanov
- Institute of Mechanics of Moscow State University, Moscow, Russian Federation
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Abstract
BACKGROUND The gallbladder filling and emptying cycle controls bile flow into the duodenum. Disruption of this emptying and refilling cycle leads to bile stasis and subsequent gallstone formation. The bile flow rate is inversely proportional to its viscosity. Moreover, bile is a complex material with varying density in different people because of its diverse components. These density changes alter the viscosity. Prediction of shear viscosity from density measurements may thus contribute to medical assessment and treatment of the patient. OBJECTIVE To investigate the relationship between the shear viscosity and density of bile. METHODS Natural and filtered bile samples were prepared for density, viscosity and pressure drop measurements. The density and shear viscosity were measured by a density meter and viscometer, respectively, and a relationship was established between them. Measurements of the pressure drop in a glass tube were used to estimate the apparent viscosity and compared with shear viscosity obtained with the viscometer. RESULTS The natural bile with higher density showed a greater shear viscosity than the filtered bile, especially at low shear rates. Bile viscosity was proportional to density. In addition, the pressure drop of the natural samples was greater than that of the filtered sample. The viscosity measured by the viscometer deviated from the results obtained using Poiseuille's law and the tube pressure drop measurements. The density difference between the natural and filtered bile samples was smaller than 1%. However, the viscosities of the natural and filtered bile samples varied by up to >30%. CONCLUSIONS Porcine bile viscosity is proportional to density. Based on the bile density, one can easily evaluate the shear viscosity using a linear relationship. The density considerably influences the bile viscosity, with small density increases greatly increasing the shear viscosity.
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Affiliation(s)
- Nguyen Ngoc Minh
- Department of Mechanical Systems Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Hiromichi Obara
- Department of Mechanical Systems Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
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Shatzel J, Kim J, Sampath K, Syed S, Saad J, Hussain ZH, Mody K, Pipas JM, Gordon S, Gardner T, Rothstein RI. Drug eluting biliary stents to decrease stent failure rates: A review of the literature. World J Gastrointest Endosc 2016; 8:77-85. [PMID: 26839648 PMCID: PMC4724033 DOI: 10.4253/wjge.v8.i2.77] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/11/2015] [Accepted: 10/28/2015] [Indexed: 02/05/2023] Open
Abstract
Biliary stenting is clinically effective in relieving both malignant and non-malignant obstructions. However, there are high failure rates associated with tumor ingrowth and epithelial overgrowth as well as internally from biofilm development and subsequent clogging. Within the last decade, the use of prophylactic drug eluting stents as a means to reduce stent failure has been investigated. In this review we provide an overview of the current research on drug eluting biliary stents. While there is limited human trial data regarding the clinical benefit of drug eluting biliary stents in preventing stent obstruction, recent research suggests promise regarding their safety and potential efficacy.
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Multicenter trial evaluating the use of covered self-expanding metal stents in benign biliary strictures: time to revisit our therapeutic options? J Clin Gastroenterol 2013; 47:695-9. [PMID: 23442836 DOI: 10.1097/mcg.0b013e31827fd311] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS. AIM : To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS. PATIENTS AND METHODS Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study.Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications. RESULTS A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as follows: postsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)]. CONCLUSIONS FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time.
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Farnbacher MJ, Kraupa W, Schneider HT. Cleaning of occluded biliary endoprostheses: Is shockwave application an alternative to regular stent exchange? J Med Eng Technol 2012; 37:10-6. [DOI: 10.3109/03091902.2012.728673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Farnbacher MJ, Lederer R, Blana A, Schneider HT. Does heparin coating reduce encrustation of biliary plastic endoprostheses? A prospective randomized trial. Scand J Gastroenterol 2012; 47:1141-7. [PMID: 22861490 DOI: 10.3109/00365521.2012.711849] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Common bile duct stenting is widely performed for bridging benign and malignant obstructions. A major limitation is early stent occlusion making regular stent exchange necessary. Covalent binding of glycosaminoglycanes to polyethylene stents proved to reduce encrustation in urological implants. Since development of urological and biliary stent occlusion shows parallels, the aim of the study was to evaluate the efficacy of heparin coating of biliary endoprostheses in preventing encrustation. MATERIAL AND METHODS In a prospective randomized trial, heparin-coated and native stents were endoscopically placed for almost 90 days on average. After removal, all stents were dried (50°C, 24 h), weighed and after longitudinal incision visible encrustation and discoloration recorded. Fifty-three patients (21 females/32 males, 70 ± 12 (42-87) years) were included; 13 patients (4 females/9 males, 58-79 years) completed the study according to the protocol. RESULTS After removal, mean weight of encrustation in native stents was more than double as high as of covered stents (native: 37.9 ± 19.8 (16-93) mg; covered: 17.6 ± 6.7 (9-33) mg). In 12 of 13 cases, the encrustation weight of the native stent was higher than that of the corresponding covered stent in the same patient. Premature stent explantation became necessary in 3 of 13 native stents, because of recurrent jaundice or cholangitis but only in 1 of 13 covered stents. After longitudinal incision, the three uncovered stents showed excessive encrustation whereas no significant encrustation was found in the covered prosthesis. Altogether, covered stents showed less visible accumulation of clogging material and discoloration than native stents. CONCLUSIONS Covalent bound heparin is highly effective in preventing encrustation of biliary polyethylene endoprostheses.
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Affiliation(s)
- Michael J Farnbacher
- Department of Medicine 2, Teaching Hospital Klinikum Fuerth, Friedrich-Alexander University Erlangen-Nuremberg, Jakob-Henle-Strasse 1, Fuerth, Germany.
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AL-ATABI M, CHIN SB, LUO XY. VISUALIZATION EXPERIMENT OF FLOW STRUCTURES INSIDE TWO-DIMENSIONAL HUMAN BILIARY SYSTEM MODELS. J MECH MED BIOL 2011. [DOI: 10.1142/s0219519406001911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although little is known about the transport mechanism of bile in the human biliary system, clinical studies suggest that it may be a contributing factor in the pathogenesis of cholelithiasis. This paper reports an investigation of the steady flow in two-dimensional human biliary system models using flow visualization. The geometries of these two-dimensional models were described based on actual patients' operative cholangiograms. Two models were used: one represented biliary system of a patient suffering from gallstones, while the second represented the biliary system of a healthy person. The streamlines of the flow in the cystic duct of the patient suffering from gallstones were highly winding, compared with those of the healthy person. This is an indication of a higher resistance to the flow in the cystic duct of the gallstone patient, which is a contributing factor of the formation of gallstones. The work presented here is a part of an ongoing project aimed at understanding the functions of human cystic duct and the role of bile flow in the formation of gallstones.
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Affiliation(s)
- M. AL-ATABI
- Department of Mechanical Engineering, University of Sheffield, Sheffield S1 3JD, South Yorkshire, UK
| | - S. B. CHIN
- Department of Mechanical Engineering, University of Sheffield, Sheffield S1 3JD, South Yorkshire, UK
| | - X. Y. LUO
- Department of Mathematics, University of Glasgow, Glasgow, UK
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Non-Newtonian Bile Flow in Elastic Cystic Duct: One- and Three-Dimensional Modeling. Ann Biomed Eng 2008; 36:1893-908. [DOI: 10.1007/s10439-008-9563-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Accepted: 09/04/2008] [Indexed: 01/14/2023]
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Li WG, Luo XY, Johnson AG, Hill NA, Bird N, Chin SB. One-dimensional models of the human biliary system. J Biomech Eng 2007; 129:164-73. [PMID: 17408321 DOI: 10.1115/1.2472379] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This paper studies two one-dimensional models to estimate the pressure drop in the normal human biliary system for Reynolds number up to 20. Excessive pressure drop during bile emptying and refilling may result in incomplete bile emptying, leading to stasis and subsequent formation of gallbladder stones. The models were developed following the group's previous work on the cystic duct using numerical simulations. Using these models, the effects of the biliary system geometry, elastic property of the cystic duct, and bile viscosity on the pressure drop can be studied more efficiently than with full numerical approaches. It was found that the maximum pressure drop occurs during bile emptying immediately after a meal, and is greatly influenced by the viscosity of the bile and the geometric configuration of the cystic duct, i.e., patients with more viscous bile or with a cystic duct containing more baffles or a longer length, have the greatest pressure drop. It is found that the most significant parameter is the diameter of the cystic duct; a 1% decrease in the diameter increases the pressure drop by up to 4.3%. The effects of the baffle height ratio and number of baffles on the pressure drop are reflected in the fact that these effectively change the equivalent diameter and length of the cystic duct. The effect of the Young's modulus on the pressure drop is important only if it is lower than 400 Pa; above this value, a rigid-walled model gives a good estimate of the pressure drop in the system for the parameters studied.
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Affiliation(s)
- W G Li
- Department of Mechanical Engineering, University of Sheffield, Sheffield, S1 3JD, UK
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Abstract
This paper reviews the progress made in understanding the mechanical behaviour of the biliary system. Gallstones and diseases of the biliary tract affect more than 10% of the adult population. The complications of gallstones, i.e. acute pancreatitis and obstructive jandice, can be lethal, and patients with acalculous gallbladder pain often pose diagnostic difficulties and undergo repeated ultrasound scans and oral cholecystograms. Moreover, surgery to remove the gallbladder in these patients, in an attempt to relieve the symptoms, gives variable results. Extensive research has been carried out to understand the physiological and pathological functions of the biliary system, but the mechanism of the pathogenesis of gallstones and pain production still remain poorly understood. It is believed that the mechanical factors play an essential role in the mechanisms of the gallstone formation and biliary diseases. However, despite the extensive literature in clinical studies, only limited work has been carried out to study the biliary system from the mechanical point of view. In this paper, we discuss the state of art knowledge of the fluid dynamics of bile flow in the biliary tract, the solid mechanics of the gallbladder and bile ducts, recent mathematical and numerical modelling of the system, and finally the future challenges in the area.
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Affiliation(s)
- Xiaoyu Luo
- Department of Mathematics, University of Glasgow, Glasgow, G12 8QW, United Kingdom.
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Hammarström LE. Endobiliary stents for palliation in patients with malignant obstructive jaundice. J Clin Gastroenterol 2005; 39:413-21. [PMID: 15815210 DOI: 10.1097/01.mcg.0000159270.35609.3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Endobiliary drainage for malignant obstructive jaundice presents a viable palliative alternative. Its role and efficacy depend on factors related to the stent, procedure, and patient. GOALS To review the evidence in the literature in which settings plastic or metal stents are cost-effective, and whether adjuvant measures or patient-related factors affect duration of stent patency. STUDY Using databases a literature search was performed for papers published from 1979 to April 2004. All retrieved papers reporting experimental or clinical observations were rated according to strength of evidence, and carefully analyzed. RESULTS AND CONCLUSIONS Metal stents (Wallstent) stay patent longer than plastic stents (large-bore polyethylene with side-holes), overall median 250 and 110 days, respectively, and seem cost-effective in patients with longer than about 6 months survival, which cannot be accurately predicted. Antibiotics or choleretic agents do not prolong stent patency in clinical settings. In case of stent occlusion, indicated stent exchanges and insertion of a plastic stent, respectively, seem cost-effective in patients initially treated with plastic and metal stents.
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Chan G, Barkun J, Barkun AN, Valois E, Cohen A, Friedman G, Parent J, Love J, Enns R, Baffis V, Jabbari M, Szego P, Stein L, Abraham N. The role of ciprofloxacin in prolonging polyethylene biliary stent patency: a multicenter, double-blinded effectiveness study. J Gastrointest Surg 2005; 9:481-8. [PMID: 15797227 DOI: 10.1016/j.gassur.2004.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Plastic stents are the mainstay of the palliation of malignant jaundice but are complicated by recurrent obstruction. Previous trials have failed to demonstrate any improvement in patency with the use of antibiotics. Patients with malignant jaundice were randomized in a double-blind fashion, after polyethylene stent insertion, to receive ciprofloxacin or placebo. After successful stent decompression, there were 50 patients in the treatment arm and 44 in the placebo. There were 14 (33%) episodes of stent occlusion in the ciprofloxacin group versus 23 (49%) in placebo (chi(2) test, P=0.115). There was no significant difference in patency (log-rank test, P=0.17). There were significantly fewer episodes of cholangitis with ciprofloxacin: 10 (23%) versus 21 (42%) in the placebo (P=0.047). The ciprofloxacin group also demonstrated a significant improvement in the Social Function domain of the SF-36 Quality of Life Survey at 1 month (paired T test, P=0.03). The other domains of the SF-36 were not different, nor was survival (log rank, P=0.80). There is insufficient evidence to show that prophylactic ciprofloxacin can prolong plastic biliary stent patency. The observed trends suggest that ciprofloxacin significantly decreases the incidence of cholangitis and results in improvements in certain aspects of quality of life.
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Affiliation(s)
- Gabriel Chan
- Department of Clinical Epidemiology, McGill University, Montreal, Canada
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Ooi RC, Luo XY, Chin SB, Johnson AG, Bird NC. The flow of bile in the human cystic duct. J Biomech 2005; 37:1913-22. [PMID: 15519599 DOI: 10.1016/j.jbiomech.2004.02.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2004] [Indexed: 12/24/2022]
Abstract
Clinical studies suggest that the flow of bile in the biliary system may be a contributing factor in the pathogenesis of cholelithiasis, but little is known about its transport mechanism. This paper reports a numerical study of steady flow in human cystic duct models. In order to obtain parametric data on the effects of various anatomical features in the cystic duct, idealised models were constructed, first with staggered baffles in a channel to represent the valves of Heister and lumen. The qualitative consistency of these findings are validated by modelling two of the real cystic ducts obtained from operative cholangiograms. Three-dimensional (3D) models were also constructed to further verify the two-dimensional (2D) results. It was found that the most significant geometric parameter affecting resistance is the baffle clearance (lumen size), followed by the number of baffles (number of folds in the valves of Heister), whilst the least significant ones are the curvature of the cystic duct and the angle between the neck and the gallbladder. The study presented here forms part of a larger project to understand the functions of the human cystic duct, especially the influence of its various anatomical structures on the resistance to bile flow, so that it may aid the assessment of the risk of stone formation in the gallbladder.
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Affiliation(s)
- R C Ooi
- Department of Mechanical Engineering, The University of Sheffield, Mappin Street, Sheffield, S1 3JD, UK
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Zhang H, Tsang TK, Jack CA. Bile glycoprotein mucin in sludge occluding biliary stent. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2003; 142:58-65. [PMID: 12878987 DOI: 10.1016/s0022-2143(03)00087-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic biliary stenting is a common treatment for the palliation of obstructive jaundice caused by inoperable malignant hepatobiliary tumors and benign strictures. The biliary stent, however, often becomes nonfunctional as a result of occlusion. In this study, we sought to confirm that bile glycoprotein mucin was a factor in stent occlusion and to investigate its possible role in biliary-stent blockage. The high-molecular-weight glycoprotein fraction was isolated from stent sludge with the use of gel filtration and a cesium chloride density gradient. This fraction was analyzed for amino-acid and carbohydrate compositions and was identified by means of immunoblotting with a specific monoclonal antibody against human gallbladder mucin. Furthermore, the distribution of bile glycoprotein mucin in stent sludge was immunologically demonstrated with fluorescent antibody, and the relationship between bile glycoprotein mucin and bacteria (demonstrated with DAPI stain) was observed. The high-molecular-weight glycoprotein extracts isolated from 11 patients' stent sludge showed strongly positive immunoreactivity with the monoclonal antibody against human gallbladder mucin. Immunofluorescence studies showed that very bright fluorescent signals of bile glycoprotein mucin often appeared on the surface of pigmented deposits, at the periphery of clumps of bacteria and along the inner wall of stents. In nonpigmented sludge, we noted fluorescent signals of bile glycoprotein mucin dispersed among clumps of bacteria. Bile glycoprotein mucin is a constituent of stent sludge. It may play a role in stent occlusion by affecting bacterial adherence to the stent surface or by promoting stent-sludge accumulation as one kind of cement among substances such as calcium bilirubinate and clumps of bacteria.
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Affiliation(s)
- Hongjun Zhang
- Division of Gastroenterology, Department of Medicine, ENH Research Institute, Northwestern University Medical School, Evanston, IL 60201, USA
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Zhang H, Tsang TK, Jack CA, Pollack J. Role of bile mucin in bacterial adherence to biliary stents. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2002; 139:28-34. [PMID: 11873242 DOI: 10.1067/mlc.2002.120257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Biliary stent placement is a well-established method of relieving obstructive jaundice. However, a frequent complication is occlusion of the stent caused by bacterial biofilm formation and sludge accumulation. In this study we investigated the possible effect of bile mucin on bacterial adherence to biliary stents at the initial stage of biofilm formation. By means of an in vitro bile-perfusion system, polyethylene stents were perfused with pig gallbladder bile infected with Escherichia coli. The concentrations of mucin in the pig bile were adjusted with purified mucin. The amount of bacteria adhering to the inner surface of the stents was measured and compared for stents perfused with bile containing various concentrations of mucin. Furthermore, we conditioned the stent inner surface with purified pig bile mucin and observed the effect of the conditioning on subsequent bacterial adherence. In addition, a common method for assaying bacterial adhesion with polystyrene microtiter plates was also used in this study. The results demonstrated that more bacteria adhered to the inner surface of stents perfused with bile containing 5 mg/mL mucin than of those perfused with bile containing 0.5 and 0 mg/mL mucin. Increased bacterial adherence was demonstrated on the stent surfaces conditioned with purified mucin compared with that seen on the nonconditioned stent surfaces. The optical densities indicating bacterial adhesion in the microtiter plate wells precoated with mucin were higher than those in non-coated plate wells. The in vitro results indicate that when a biliary stent is implanted in vivo, mucin in bile may condition the stent inner surface, modulate subsequent bacterial adherence to the surface, and participate in stent occlusion.
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Affiliation(s)
- Hongjun Zhang
- Division of Gastroenterology, Department of Medicine, ENH Research Institute, Northwestern University Medical School, Evanston, Illinois, USA
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Jüngst D, Niemeyer A, Müller I, Zündt B, Meyer G, Wilhelmi M, del Pozo R. Mucin and phospholipids determine viscosity of gallbladder bile in patients with gallstones. World J Gastroenterol 2001; 7:203-7. [PMID: 11819761 PMCID: PMC4723523 DOI: 10.3748/wjg.v7.i2.203] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: An increased viscosity of gallbladder bile has been considered an important factor in the pathogenesis of gallstone disease. Besides lipids and proteins, mucin has been suggested to affect the viscosity of bile. To further clarify these issues we compared mucin, protein and the lipid componEnts of hepatic and gallbladder bile and its viscosity in patients with gallstones.
METHODS: Viscosity of bile (mPa.s) was measured using rotation viscosimetry in regard to the non Newtonian property of bile at low shear rates.
RESULTS: Biliary viscosity was markedly higher in gallbladder bile of patients with cholesterol (5.00 ± 0.60 mPa.s, mean ± SEM, n = 28) and mixed stones (3.50 ± 0.68 mPa.s; n = 8) compared to hepatic bile (0.92 ± 0.06 mPa.s, n = 6). A positive correlation between mucin and viscosity was found in gallbladder biles (r = 0. 65; P < 0.001) but not in hepatic biles. The addition of physiologic and supraphysiologic amounts of mucin to gallbladder bile resulted in a dose dependent non linear increase of its viscosity. A positive correlation was determined between phospholipid concentration and viscosity (r = 0.34, P < 0.005) in gallbladder biles. However, no correlation was found between total protein or the other lipid concentrations and viscosity in both gallbladder and hepatic biles.
CONCLUSION: The viscosity of gallbladder bile is markedly higher than that of hepatic bile in patients with gallstones. The concentration of mucin is the major determinant of biliary viscosity and may contribute by this mechanism to the role of mucin in the pathogenesis of gallstones.
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Affiliation(s)
- D Jüngst
- Department of Medicine II, Klinikum Grosshadern, Marchioninistr. 15, 81377 Munich, Germany
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Tiffon B, Parquet M, Dubrac S, Lutton C, Volk A. In vivo gallbladder bile diffusion coefficient measurement by diffusion-weighted echo planar imaging in hamster fed normal and lithogenic diets. Magn Reson Med 2000; 43:854-9. [PMID: 10861880 DOI: 10.1002/1522-2594(200006)43:6<854::aid-mrm11>3.0.co;2-e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
It is shown that in vivo measurement of bile water apparent diffusion coefficient (ADC) by diffusion-weighted echo-planar imaging (EPI) in hamster gallbladder is possible providing motion artifact-free ADC values. These ADC values are used to estimate bile viscosity variation induced by normal diets, cholesterol gallstone-inducing diets, and an antilithiasic drug, and to determine if a link exists between bile viscosity and cholesterol gallstone formation. Measurements were performed at 4.7 T with respiratory triggering in five groups of hamsters fed a commercial (RC) or a semisynthetic (SSD) diet, a SSD containing 0.2% hyodeoxycholic acid (SSD+HDC) and two lithogenic diets (LD5, LD10). ADC decreased significantly in LD10 (2.15+/-0.07x 10(-3) mm(2)s(-1)) and SSD+HDC (2.03+/-0.04) compared to RC (2.40+/-0.05) but not in the most lithogenic LD5 diet (2.33+/-0.06). No direct relationship was found between bile viscosity and gallstone incidence; however, viscosity seems to be related to lipid contents of diets. Magn Reson Med 43:854-859, 2000.
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Affiliation(s)
- B Tiffon
- Unité INSERM 350, Institut Curie, Centre Universitaire, Orsay, France.
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Rees EN, Tebbs SE, Elliott TS. Role of antimicrobial-impregnated polymer and Teflon in the prevention of biliary stent blockage. J Hosp Infect 1998; 39:323-9. [PMID: 9749404 DOI: 10.1016/s0195-6701(98)90298-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Biliary stent blockage and microbial colonization is a common complication associated with polyurethane stents used for the relief of bile-duct obstruction caused by benign or malignant disease. In an attempt to overcome this problem the application of a 'Teflon' (polytetrafluoroethylene) stent and an antimicrobial benzalkonium chloride (BZC) impregnated polymer were investigated. The effects of these materials on microbial colonization were compared to a polyurethane stent in vitro in broth or bile. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of BZC for three commonly isolated biliary stent pathogens, Staphylococcus epidermidis, Enterococcus faecium and Enterobacter cloacae were also determined. All the isolates were sensitive to BZC. The growth kinetics of the three organisms in broth and in human pooled bile were similar. Adherence to the BZC impregnated polymer was significantly reduced as compared to the polyurethane and Teflon stents (P < 0.05) in nutrient broth. In bile, fewer organisms attached to the Teflon as compared with the polyurethane stent (P < 0.05) for all organisms. For two of the three test organisms there was less bacterial adherence to the Teflon than to the BZC impregnated polymer. The Teflon and antimicrobial stent materials studied may prevent biliary stent blockage resulting from microbial colonization.
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Affiliation(s)
- E N Rees
- Department of Clinical Microbiology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, UK
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