Cargando…

Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model

BACKGROUND: Fully covered Self-Expanding metal stents (FCSEMS) have been shown efficacious in palliating malignant biliary obstructions. There is little data analyzing mucosal response to their temporary placement in the bile duct. METHODS: Ten mini pigs underwent endoscopic placement of a FCSEMS (W...

Descripción completa

Detalles Bibliográficos
Autores principales: Bakhru, Mihir R, Foley, Patricia L, Gatesman, Jeremy, Schmitt, Timothy, Moskaluk, Christopher A, Kahaleh, Michel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142530/
https://www.ncbi.nlm.nih.gov/pubmed/21689439
http://dx.doi.org/10.1186/1471-230X-11-76
_version_ 1782208840181219328
author Bakhru, Mihir R
Foley, Patricia L
Gatesman, Jeremy
Schmitt, Timothy
Moskaluk, Christopher A
Kahaleh, Michel
author_facet Bakhru, Mihir R
Foley, Patricia L
Gatesman, Jeremy
Schmitt, Timothy
Moskaluk, Christopher A
Kahaleh, Michel
author_sort Bakhru, Mihir R
collection PubMed
description BACKGROUND: Fully covered Self-Expanding metal stents (FCSEMS) have been shown efficacious in palliating malignant biliary obstructions. There is little data analyzing mucosal response to their temporary placement in the bile duct. METHODS: Ten mini pigs underwent endoscopic placement of a FCSEMS (Wallflex, Boston Scientific). FCSEMS were kept in place for three months. At the end of the 3 months, FCSEMS were removed endoscopically. Five pigs were euthanized and their bile ducts harvested. The other five were kept alive for another month post removal. A single pathologist, created a scoring system (to determine degree of inflammation, fibrosis, and epithelial injury), examined all specimens in a blinded fashion. RESULTS: Four FCSEMS spontaneously migrated in the duodenum. On post mortem examination, mild mucosal thickness was noted in three bile duct specimens while superficial inflammation of the bile duct was noted in five animals. Histologic examination of the bile duct revealed focal acute inflammation in both groups. For the 5 animals euthanized immediately after stent removal, there was a tendency to have superficial mucosal erosion and fibrosis. In contrast, increased chronic inflammation was more commonly seen in the animals 1 month post stent removal, with all animals in this group showing moderate degrees of mononuclear inflammatory cell mucosal infiltrates. No severe inflammatory or fibrotic duct injury was observed in any of the study animals, with degree of injury graded as mild to moderate. CONCLUSION: FCSEMS appear to induce minimal tissue overgrowth or fibrosis post placement. Ease of removability and no significant histologic injury are advantages noted with FCSEMS., however, further studies are needed to evaluate treating benign biliary strictures with FCSEMS in humans.
format Online
Article
Text
id pubmed-3142530
institution National Center for Biotechnology Information
language English
publishDate 2011
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-31425302011-07-24 Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model Bakhru, Mihir R Foley, Patricia L Gatesman, Jeremy Schmitt, Timothy Moskaluk, Christopher A Kahaleh, Michel BMC Gastroenterol Research Article BACKGROUND: Fully covered Self-Expanding metal stents (FCSEMS) have been shown efficacious in palliating malignant biliary obstructions. There is little data analyzing mucosal response to their temporary placement in the bile duct. METHODS: Ten mini pigs underwent endoscopic placement of a FCSEMS (Wallflex, Boston Scientific). FCSEMS were kept in place for three months. At the end of the 3 months, FCSEMS were removed endoscopically. Five pigs were euthanized and their bile ducts harvested. The other five were kept alive for another month post removal. A single pathologist, created a scoring system (to determine degree of inflammation, fibrosis, and epithelial injury), examined all specimens in a blinded fashion. RESULTS: Four FCSEMS spontaneously migrated in the duodenum. On post mortem examination, mild mucosal thickness was noted in three bile duct specimens while superficial inflammation of the bile duct was noted in five animals. Histologic examination of the bile duct revealed focal acute inflammation in both groups. For the 5 animals euthanized immediately after stent removal, there was a tendency to have superficial mucosal erosion and fibrosis. In contrast, increased chronic inflammation was more commonly seen in the animals 1 month post stent removal, with all animals in this group showing moderate degrees of mononuclear inflammatory cell mucosal infiltrates. No severe inflammatory or fibrotic duct injury was observed in any of the study animals, with degree of injury graded as mild to moderate. CONCLUSION: FCSEMS appear to induce minimal tissue overgrowth or fibrosis post placement. Ease of removability and no significant histologic injury are advantages noted with FCSEMS., however, further studies are needed to evaluate treating benign biliary strictures with FCSEMS in humans. BioMed Central 2011-06-20 /pmc/articles/PMC3142530/ /pubmed/21689439 http://dx.doi.org/10.1186/1471-230X-11-76 Text en Copyright ©2011 Bakhru et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Bakhru, Mihir R
Foley, Patricia L
Gatesman, Jeremy
Schmitt, Timothy
Moskaluk, Christopher A
Kahaleh, Michel
Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model
title Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model
title_full Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model
title_fullStr Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model
title_full_unstemmed Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model
title_short Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model
title_sort fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142530/
https://www.ncbi.nlm.nih.gov/pubmed/21689439
http://dx.doi.org/10.1186/1471-230X-11-76
work_keys_str_mv AT bakhrumihirr fullycoveredselfexpandingmetalstentsplacedtemporarilyinthebileductsafetyprofileandhistologicclassificationinaporcinemodel
AT foleypatricial fullycoveredselfexpandingmetalstentsplacedtemporarilyinthebileductsafetyprofileandhistologicclassificationinaporcinemodel
AT gatesmanjeremy fullycoveredselfexpandingmetalstentsplacedtemporarilyinthebileductsafetyprofileandhistologicclassificationinaporcinemodel
AT schmitttimothy fullycoveredselfexpandingmetalstentsplacedtemporarilyinthebileductsafetyprofileandhistologicclassificationinaporcinemodel
AT moskalukchristophera fullycoveredselfexpandingmetalstentsplacedtemporarilyinthebileductsafetyprofileandhistologicclassificationinaporcinemodel
AT kahalehmichel fullycoveredselfexpandingmetalstentsplacedtemporarilyinthebileductsafetyprofileandhistologicclassificationinaporcinemodel