Why Do Bilioduodenal Plastic Stents Become Occluded? A Clinical and Pathological Investigation on 100 Consecutive Patients

BACKGROUND AND STUDY AIMS: The main complication associated with biliary stenting is stent occlusion. This study tested the hypothesis that bilioduodenal reflux may play a crucial role in stent clogging. PATIENTS AND METHODS: Plastic stents in 100 consecutive patients with various biliary disorders were investigated macroscopically and cytologically. RESULTS: In 37 patients with elective stent extraction, the only risk factor for stent occlusion was the duration of stenting. Plant material was found as a consequence of duodenobiliary reflux in 38 of the 89 stents with any stent content. In patients who had two stents, the stent content was identical in eight of 14 cases. CONCLUSIONS: In addition to other mechanisms of biliary stent occlusion, duodenobiliary reflux appears to play an important role. A stent design capable of at least partly preventing this type of reflux might be of clinical benefit.