PubMed · 8979077
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W Silverman. 1996. Rapid and simple biliary stent deployment.. https://doi.org/10.1016/s0016-5107(96)70071-8
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BACKGROUND: Clogging of biliary stents remains an important problem. In vitro studies have shown less sludge formation in Teflon stents. Recently, clinical studies with Teflon stents have produced contradictory results. The aim of this study was to investigate whether the surface properties of the endoprostheses could explain the variation observed in clinical studies. METHODS: A total of 9 different types of unused 10F endoprostheses were examined by scanning electron microscopy (SEM): polyethylene Amsterdam-type, polyurethane Amsterdam-type, Teflon Amsterdam-type, Teflon Tannenbaum-type and a Tannenbaum-type stent with a thin stainless steel mesh between inner and outer layers. RESULTS: All polyethylene stents had a relief with tiny lumps. All Teflon stents had multiple shallow pits and ridges along the entire longitudinal axis. Both Tannenbaum-type stents also had multiple particles protruding into the stent lumen with adjacent holes in the wall of the stent. The polyurethane stent had an extremely smooth surface. CONCLUSION: SEM of Teflon made stents showed a markedly irregular inner surface, which may explain the controversial results of clinical studies. Our results indicate that the inner surface of a new stent should first be evaluated by SEM before clinical trials are initiated.
DIAGNOSIS: Pruritus in a pregnant women with healthy skin is suggestive of gravid cholestasis. The diagnosis can only be retained after ruling out viral or drug-induced hepatitis or gallbladder disease. The best markers are maternal serum transaminase and bile acid levels. FETAL RISK: The perinatal consequences of gravid cholestasis are minimal if reasonable premature delivery is accepted. THERAPEUTIC OPTIONS: Ursodesoxycholic acid is an interesting therapeutic option if pruritus is untolerable or if the diagnosis is made early in pregnancy. Injection of vitamin K prevents coagulation disorders.
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