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Ivan M Lang - One of the best experts on this subject based on the ideXlab platform.
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impact of reducing duodenoBiliary reflux on Biliary Stent patency an in vitro evaluation and a prospective randomized clinical trial that used a Biliary Stent with an antireflux valve
Gastrointestinal Endoscopy, 2007Co-Authors: Nageshwar D Reddy, Bidyut K Medda, Rupa Banerjee, Ivan M LangAbstract:Background The mechanisms leading to occlusion of plastic Biliary Stents (PBS) are not known. Objective To evaluate the impact of reducing duodenoBiliary reflux on Stent patency rate. Design A newly designed antireflux PBS (AR-PBS) was tested in vitro by using ox bile. A prospective randomized trial in human beings was conducted. Setting Tertiary medical center. Patients Patients with malignant bile-duct strictures were studied. Interventions A PBS or an AR-PBS Stent was placed by using standard techniques, and the patients were followed at regular intervals. Patients presenting with Stent occlusion underwent re-Stent placement with either a PBS or a metal Stent. Main Outcome Measurements In vitro: resistance to retrograde flow and comparison of the basal and peak antegrade flow pressures between the 2 Stents. In vivo: Stent patency rates, complications, and the efficacy of the Stents in improving the liver test. Results The AR-PBS Stent could withstand a retrograde pressure gradient of >320 mm Hg compared with P P = .002). Both Stents were equally effective in improving the liver test, and complication rates were similar in the 2 groups. Limitations The occluded Stents were not examined microscopically. Conclusions The antireflux Biliary Stent remains patent for a longer time and hence duodenoBiliary reflux may be contributing to Stent occlusion.
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in vitro evaluation of a Biliary Stent with an anti duodenoBiliary reflux valve using ox bile perfused at physiological bile flow rates
Gastrointestinal Endoscopy, 2006Co-Authors: Bidyut K Medda, Ivan M LangAbstract:In Vitro Evaluation of a Biliary Stent with an Anti-DuodenoBiliary Reflux Valve Using Ox Bile Perfused At Physiological Bile Flow Rates Kulwinder S. Dua, B. Medda, I. Lang Background: A recent prospective randomized study on patients with Biliary strictures showed that a plastic Biliary Stent with a windsock anti-duodenoBiliary reflux valve (AR Stent) remained patent for a longer time compared to a standard Stent(S Stent) (Dua, Gut 2005). In an earlier study, this AR Stent was evaluated in vitro using water perfused at 22-44 ml/min. Aim: The aim of the present study was to evaluate the AR Stent using bile instead of water perfused around physiological bile flow rates (0.5 to 1.5 ml per minute; Boyer J Clin Invest 1974; Hofmann Gastroenterology 1978). Method: A 10F, 7cm Tannenbaum Stent was modified by attaching a 4 cm windsock valve at its duodenal end. Ox bile (Crescent Chemicals) at 37 C was perfused through the Stent using a minimally compliant perfusion system with a pump (SP 100i Syringe Pump System, U.S.A.) where the flow rate was controlled electronically. Stents were placed horizontally at the level of the pressure transducer with the valve drooping downwards. At perfusion rates of 0.5 ml, 1 ml, and 2.5 ml per minute, basal and peak resistance pressures to antegrade flow were digitally recorded using the WinDaq Waveform Browser (Dataq Instruments U.S.A.). Anti-reflux ability of the Stent was determined by placing the valve end of the Stent into a glass chamber and recording the rise in pressure on reverse perfusion into the chamber. Antegrade and retrograde flow resistance pressures were compared with a standard Tannenbaum Stent of same diameter and length. Results: Mean basal (perfusion pump off) and peak (perfusion pump on) pressure resistance offered by the AR and S Stents to antegrade flow of bile are shown in table. Secondary to siphon effect of the valve, the AR Stent generated negative pressures compared to the S Stent. On reverse perfusion, the pressure within the glass chamber rose to the maximum allowed 320 mmHg with the AR Stent. No such rise in pressure was noted with the S Stent. Conclusions: Anti-reflux valve attached to a Biliary Stent does not offer increased resistance to the flow of bile but on the contrary may help antegrade flow by generating negative pressure by siphon effect. The valve is effective in preventing retrograde flow.
John J Kim - One of the best experts on this subject based on the ideXlab platform.
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predictors and outcomes of delayed plastic Biliary Stent removal following endoscopic retrograde cholangiopancreatography
Scandinavian Journal of Gastroenterology, 2017Co-Authors: Shawn J Kim, Edmond Ohanian, Frances Lee, Bryan Nam, Kendrick Che, Loren Laine, Sarah E Kim, John J KimAbstract:AbstractObjective: Plastic Biliary Stents are commonly placed during endoscopic retrograde cholangiopancreatography (ERCP) and should be removed or replaced within 3 months to reduce the risk of Stent obstruction. The aim of the study was to identify predictors and outcomes of patients who had delayed plastic Biliary Stent removal following ERCP.Materials and methods: Consecutive patients who received ERCP with plastic Biliary Stent placement at Loma Linda University Medical Center (10/2004–6/2013) were identified. Delayed removal was defined as presence of Stent >3 months after index ERCP. Multivariable regression analysis to identify baseline characteristics associated with delayed removal was performed. Clinical outcomes of Stent obstruction (e.g., cholangitis, hospitalization, intensive care) were also collected for those with delayed removal.Results: Among 374 patients undergoing ERCP with plastic Biliary Stent, 71 (19%) had delayed Stent removal. Patients who had anesthesia assistance (AOR = 3.8, 95...
Liming Wang - One of the best experts on this subject based on the ideXlab platform.
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spontaneously removed Biliary Stent drainage versus t tube drainage after laparoscopic common bile duct exploration
Medicine, 2016Co-Authors: Chengyong Dong, Fei Long, Keqiu Jiang, Ping Shao, Rui Liang, Liming WangAbstract:Several studies have shown the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) as a minimally invasive treatment options for choledocholithiasis. Use of T-tube or Biliary Stent drainage tube placement after laparoscopic choledochotomy for common bile duct (CBD) stones is still under debate. This study tried to confirm the safety of spontaneously removable Biliary Stent in the distal CBD after LCBDE to allow choledochus primary closure. A total of 47 patients with choledocholithiasis underwent LCBDE with primary closure and internal drainage using a spontaneously removable Biliary Stent drainage tube (Stent group, N = 22) or T-tube (T-tube group, N = 25). Operative parameters and outcomes are compared. Surgical time, intraoperative blood loss, length of hospital stay, drainage tube removal time, postoperative intestinal function recovery, and cost of treatment were all significantly lower in the Stent group as compared to that in the T-tube group (P 0.05). The Biliary Stent drainage tube was excreted spontaneously 4 to 14 days after surgery with the exception of one case, where endoscopic removal of Biliary tube was required due to failure of its spontaneous discharge. LCBDE with primary closure and use of spontaneously removable Biliary Stent drainage showed advantage over the use of traditional T-tube drainage in patients with choledocholithiasis.
Do Hyun Park - One of the best experts on this subject based on the ideXlab platform.
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the number of wire placement in the pancreatic duct and metal Biliary Stent as risk factors for post endoscopic retrograde cholangiopancreatography pancreatitis
Journal of Gastroenterology and Hepatology, 2020Co-Authors: Seung Hwan Shin, Sunghee Cho, Nayoung Kim, Gwang Ho Baik, Sung Koo Lee, Do Hyun ParkAbstract:Background and aim Many post-ERCP pancreatitis (PEP) risk factors, including pancreatic duct cannulation, have been identified; however, whether the number of repeated and unintentional wire placements (WPs) in the pancreatic duct during wire-guided cannulation affects PEP risk is unknown. We aimed to identify the effects of repeated WP in the pancreatic duct and other potential risk factors on PEP incidence. Methods We retrospectively analyzed 877 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP). We examined potential patient-related and procedure-related risk factors, and PEP incidence by univariable and multivariable logistic regression analyses. Results Thirty-four patients (3.9%) had PEP. Univariable analysis revealed younger age, malignant common bile duct or ampulla of Vater stricture, two or more episodes of WPs in the pancreatic duct, and metal Biliary Stent as risk factors for PEP. Following multivariable analysis, two or more episodes of WPs in the pancreatic duct and metal Biliary Stent remained in the final model. PEP did not increase significantly in case of a one episode of WP (4.0%) compared with no episode of WP in the pancreatic duct (2.7%). However, patients with two episodes of WPs had 8.0% incidence and three or more episodes of WPs had 14.3%. Conclusions A WP in the pancreatic duct and a metal Biliary Stent were associated with increased PEP incidence in patients undergoing ERCP. As for the pancreatic duct wire cannulation, two or more WPs considerably increased PEP incidence. This suggests that preventive measures or alternative procedures might be considered in patients with such cases during and after ERCP.
Muhammed Ali Khan - One of the best experts on this subject based on the ideXlab platform.
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does endoscopic sphincterotomy reduce the risk of post endoscopic retrograde cholangiopancreatography pancreatitis after Biliary Stenting a systematic review and meta analysis
Digestive Endoscopy, 2016Co-Authors: Aijaz Sofi, Ali Nawras, Osama Alaradi, Yaseen Alastal, Muhammed Ali KhanAbstract:Background and Aim Endoscopic Biliary sphincterotomy (ES) is often carried out prior to placement of a Biliary Stent apparently to reduce the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, the protective effect of ES prior to Biliary Stenting is controversial. The objective of this meta-analysis is to compare the risk of PEP and other complications after the placement of Biliary Stent with or without ES in patients with Biliary obstruction and bile leak. Methods We carried out a systematic search in several electronic databases for randomized controlled trials (RCT) and observational studies (OS) comparing the risk of PEP after Biliary Stenting with or without ES. The Mantel–Haenszel method was used to pool data of adverse outcomes into fixed or random effect model meta-analyses. Results Seventeen studies (five RCT and 12 OS) with a total of 2710 patients met the inclusion criteria. No significant difference was observed in the risk of PEP with Biliary Stenting with and without ES (RD −0.01; 95% confidence interval [CI] –0.03, 0.01). In a subgroup analysis of Stenting for Biliary obstruction, no difference in the risk of PEP was observed with or without ES. However, ES was associated with lower risk of PEP in patients undergoing Biliary Stenting for bile leak (RD −0.05; CI −0.10, −0.01). Conclusions ES shows risk reduction in prevention of PEP in patients undergoing endoscopic Stenting for bile leak. However, placement of Biliary Stent without ES is not associated with an increased risk of PEP in patients with distal bile duct obstruction with involvement of pancreatic duct.