Digestive Diseases and Sciences

, Volume 61, Issue 8, pp 2426–2435 | Cite as

Time Sequence Evaluation of Biliary Stent Occlusion by Dissection Analysis of Retrieved Stents

  • Chang-Il Kwon
  • Mark A. Gromski
  • Stuart Sherman
  • Jeffrey J. Easler
  • Ihab I. El Hajj
  • James Watkins
  • Evan L. Fogel
  • Lee McHenry
  • Glen A. LehmanEmail author
Original Article


Background and Aims

Multiple factors can affect the occlusion of plastic stents. Previous data demonstrate that side holes may induce more biofilm formation probably via microturbulence and bile flow disturbances that could lead to occlusion. These results, however, have not been replicated in subsequent clinical studies with different methods. The objective of this study is to evaluate the physical characteristics of plastic stent occlusion over time.


This is a plastic stent sequential analysis study. Biliary stents removed via ERCP from February 24, 2015, to June 2, 2015, were included. One hundred and forty-eight retrieved straight-type plastic stents were longitudinally cut by a custom-made cutting device. These dissected stents were then evaluated in detail with regard to the location of stent occlusion and the stent patency period. Location of stent occlusive debris was the primary outcome in this study.


Biofilm formations and occlusions by debris were sequentially but separately tallied. Biofilm formations were initially seen around the side hole areas within 30 days and spread to the entire stent by 60 days. Then, occlusion process by debris was mainly initiated by 80 days and progressed to full occlusion by median of 90 days. Although some occlusions were also observed around the side hole areas within 30 days, affected areas were more widely observed after biofilm formation.


This study is the first to attempt to describe the distribution of stent occlusions over time. These observations may help guide future stent development.


Stents Occlusion Biofilm Debris Duodenal reflux Endoscopic retrograde cholangiopancreatography 



We would like to thank Gwangil Kim, M.D., Yong Hyun Won, Kil Soo Kim, and Se Il Kang for their cooperation, and a special acknowledgment to the Indiana University ERCP nurse team for their dedicated support and assistance during this study.

Compliance with ethical standards

Conflict of interest

All authors disclosed no financial relationships relevant to this publication.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Chang-Il Kwon
    • 1
  • Mark A. Gromski
    • 1
  • Stuart Sherman
    • 1
  • Jeffrey J. Easler
    • 1
  • Ihab I. El Hajj
    • 1
  • James Watkins
    • 1
  • Evan L. Fogel
    • 1
  • Lee McHenry
    • 1
  • Glen A. Lehman
    • 1
    Email author
  1. 1.Division of Gastroenterology/HepatologyIndiana University School of MedicineIndianapolisUSA

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