Long-term ciprofloxacin treatment for the prevention of biliary stent blockage: A prospective randomized study

OBJECTIVE: In vitro experimental and animal studies have shown that quinolo nes reduce the adherence of bacteria on a polyethylene tube and prevent ste nt blockage. Our aim was to see whether ciprofloxacin prevents stent blocka ge in patients with malignant stricture of the biliary tract. METHODS: Patients with inoperable biliary or pancreatic tumor not involving the bifurcation of the common hepatic duct were recruited. They were rando mized to receive either endoscopic stenting alone or stenting with prophyla ctic treatment of ciprofloxacin (200 mg i.v. before stenting, followed by 2 50 mg orally twice per day). In each follow-up visit, clinical symptoms of cholangitis were documented and blood samples taken for blood counts, serum levels of bilirubin, and alkaline phosphatase. Stent blockage was defined as clinical symptom(s) of cholangitis with biochemical or radiological evid ence of stent dysfunction. RESULTS: Fifty-eight patients were recruited into the study. Three patients in the stenting group and three in the ciprofloxacin group were excluded a fter randomization. Eleven patients received stenting alone and five patien ts receiving ciprofloxacin had previous endoscopic stenting. Thirteen patie nts (50%) in the ciprofloxacin group and eight patients (31%) in the stenti ng group died before stent blockage. Ten patients (38%) in each group had s tent blockage during the follow-up at 20 wk. The median stent patency was 1 1.6 wk and 11.9 wk in the ciprofloxacin group and the stenting group, respe ctively. Kaplan-Meier analysis of stent patency showed no difference betwee n the two groups. Among patients who received endoscopic stenting for the f irst time, there was a trend favoring ciprofloxacin treatment, but the diff erence was not significant. The 30-day and 20-wk mortality between the grou ps were comparable. CONCLUSION: Long-term use of ciprofloxacin does not prevent blockage of pol yethylene biliary stents. (C) 1999 by Am. Cell. of Gastroenterology.