Metal stents are effective treatment for blocked bile ducts

A multi-center analysis, led by Weill Cornell Medical College and published in the Journal of Clinical Gastroenterology, shows the use of temporary "fully covered self-expanding metal stents" (FCSEMS) can effectively fix a painful and potentially life-threatening benign biliary stricture - a severely blocked or narrowed bile duct.

"Benign biliary strictures can be managed and resolved with these new fully covered metal stents with flared ends. Our study findings are similar to the recent European study results in patients overseas who received the metal stents," says Dr. Michel Kahaleh, chief of endoscopy in the Division of Gastroenterology and Hepatology, Department of Medicine, at the Center for Advanced Digestive Care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and professor of clinical medicine at Weill Cornell Medical College.

Narrowing or blockage of a bile duct can lead to the dangerous leakage of bile into the body's organs and bloodstream. Bile is a necessary fluid produced by the liver that assists in the body's digestive process. Bile ducts are the series of thin, connected tubes that transport bile from the liver through the body to the small intestines. Patients who experience a bile duct stricture may experience jaundice, severe pain, itchiness, weight-loss, elevated liver function tests, cirrhosis and liver failure over a period of a few weeks.

Biliary strictures can be cancerous or benign. A benign stricture can occur as a result of surgical injury or trauma, pancreas inflammation, scarring or hardening of bile duct tissue caused by chronic inflammation, recurrent gallstones or poor reconnection of tissues post-liver transplantation. A biliary stricture is often diagnosed with explorative endoscopy - a procedure that uses a thin flexible camera probe to hunt for blockages, CT imaging or MRI.

Surgery once played a pivotal role in the management of benign biliary strictures, but it's associated with significant complications and mortality. Today, minimally invasive endoscopic stent placement has emerged as a less invasive and more successful therapeutic option.

Only permanent plastic stents are currently FDA approved for benign stricture indications. However, these plastic stents involve multiple endoscopic procedures and multiple large stents. Also, plastic stents are often associated with stent blockages and failure of long-term durable results for stricture resolution.

A consequence of the different cancers of the hepatobiliary system is blocked bile ducts. However, artificial catheters known as "stents" can remediate this problem. Stents are medical implants which reopen narrowed bile ducts to allow the outflow of bile. However, bacteria colonize these catheters forming dense communities, so-called biofilms. Inside these biofilms, bacteria are not only protected from the immune response initiated by the host but also from antibiotics.

Since the bacterial community is unable to be controlled via antibiotics, the catheters become blocked by the biofilms, which then have to be exchanged on a regular basis, an invasive process.Scientists of the Helmholtz-Centre for Infection Research (HZI) in Braunschweig have analyzed biliary stents from patients being treated at the medical clinics in Salzgitter and Braunschweig. They would like to know which bacteria inhabit these stents so that such knowledge can facilitate the development of medications tailored to combat against development of these biofilms. The HZI-Scientists identified specific bacterial species as main colonizers of these stents. In addition they statistically evaluated the composition of the bacterial communities of the catheters. Their results have now been published by the scientific journal International Society for Microbial Ecology Journal.