Evaluation of role of bile flow patterns in process of in vitro stent occlusion

Stent placement above the sphincter of Oddi might have advantages over stent placement across the sphincter of Oddi in prolonging stent patency in the treatment for malignant obstructive jaundice. To evaluate the role of bile flow patterns corresponding to biliary stent positioning in the process of stent occlusion in an in vitro bile perfusion model, one group of polyethylene stents was perfused continuously and another group of stents was perfused with additional flushing three times a day, simulating gallbladder emptying. After 8 weeks, the flow rates through the perfused stents were measured for evaluating the extent of stent occlusion indirectly. The results showed that bile flow rate of stents with additional flushing was significantly higher than the continuously perfused stents (P < or = 0.01). It was demonstrated that after 18 hr of perfusion, additional flushing obviously decreased bacterial adherence to stent when compared to continuously perfused stents. In conclusion, flushing of bile may decrease the build-up of substance in vitro and thus improve stent flow rates, for which decreasing bacterial adherence to stents may be responsible.