Clin Endosc.  2014 Jan;47(1):84-93.

Histological Changes in the Bile Duct after Long-Term Placement of a Fully Covered Self-Expandable Metal Stent within a Common Bile Duct: A Canine Study

Affiliations
  • 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ssleedr@amc.seoul.kr
  • 2Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 3Department of Pathology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

Abstract

BACKGROUND/AIMS
To date, it has been difficult to determine the optimal stenting duration of a fully covered self-expandable metal stent (FCSEMS) in a benign biliary stricture. The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS.
METHODS
An FCSEMS was inserted into the common bile duct of 12 canines, and the animals were divided into four groups. Posteuthanasia, necropsy was performed to examine the histopathological changes in the bile ducts after 1, 3, 6, and 9 months.
RESULTS
The results of necropsy showed that the covered membranes of the FCSEMSs were intact and easily removed from the bile ducts in 11 of the canines. Severe epithelial hyperplasia of the stented bile duct and epithelial ingrowth into the stent occurred in one animal (from the 3-month group). On histopathological examination, mild inflammatory changes were observed in the stented bile ducts, and there was no significant difference between the four groups. Among the 12 animals, five had de novo stricture.
CONCLUSIONS
An FCSEMS can be inserted into the bile duct without severe histopathological changes up until 9 months. However, a de novo stricture and severe epithelial hyperplasia relating to the stent insertion might occur.

Keyword

Stents; Common bile duct; Common bile duct disease; Cholangiopancreatography, endoscopic retrograde; Dogs

MeSH Terms

Animals
Bile Ducts*
Bile*
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct*
Constriction, Pathologic
Dogs
Hyperplasia
Membranes
Stents*

Figure

  • Fig. 1 Stent deployment under fluoroscopic guidance. (A) Cholangiography of a normal canine bile duct. (B) Fluoroscopic image of a guidewire placed inside the bile duct. (C) The stent is placed above the papilla. (D) The stent is in place after withdrawal of the delivery catheter and guidewire.

  • Fig. 2 Four levels of histopathological examination. Cross section of an unstented (normal) bile duct, and the proximal, middle, and distal portions of the stented bile duct.

  • Fig. 3 Macroscopic and microscopic findings of the stented bile duct (dog 6). (A) Macroscopic examination of the stented bile duct, showing superficial inflammation. (B) Chronic inflammation is confined to the mucosa (H&E stain, ×40). (C) There are a few neutrophils in the lamina propria (H&E stain, ×200). (D) Fibrosis extends to the muscle layer, but smooth muscle bundles are intact (red spindle cells; Masson trichrome stain, ×100).

  • Fig. 4 Macroscopic and microscopic findings of the stented bile duct with severe inflammatory changes (dog 4). (A) A fully covered self-expandable metal stent became embedded in the bile duct owing to severe epithelial hyperplasia. (B) A low-magnification view reveals transmural inflammation and fibrosis (H&E stain, ×40). (C) Suppurative inflammation with many neutrophils is visible (H&E stain, ×200). (D) Masson trichome stain highlights extensive fibrosis (blue areas; H&E stain, ×100).

  • Fig. 5 Macroscopic images of de novo stricture after removal of a fully covered self-expandable metal stent (FCSEMS). (A) De novo stricture occurred at both the proximal (arrows) and distal (arrowheads) portions of the bile ducts after placement of an FCSEMS for 9 months. (B) De novo stricture occurred at the distal portion of the bile duct after placement of an FCSEMS for 6 months (arrows).

  • Fig. 6 The results of microscopic examinations. (A) Microscopic examination of the normal (unstented) bile duct. (B) Microscopic examination of the proximal portion of the stented bile duct. (C) Microscopic examination of the middle portion of the stented bile duct. (D) Microscopic examination of the distal portion of the stented bile duct.


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