BACTERIAL BIOFILM AND CLOGGING OF BILIARY STENTS

Endoscopic biliary stenting has become a standard palliative treatment for obstructive jaundice due to malignancies of the pancreas and the hepatobiliary system. Despite the high initial success rate in achievi ng biliary drainage, durable endoscopic stenting has been limited by t he clogging of biliary stents, usually after 4-5 months, due to format ion of an adherent bacterial biofilm. Various methods have been invest igated for the prevention of bacterial adhesion and prolongation of st ent patency. These include: 1) prophylactic use of antimicrobial agent s and bile salts; 2) testing of new stent material and new designs for these biliary stents; and 3) the recent introduction of self-expandab le metal stents. Each method has its own merits as well as specific pr oblems. This article reviews the pathogenesis of biofilm formation on the biliary stents and the latest status of research in avoiding the p roblem of stent occlusion.