The wing stent facilitates repeat bile duct cannulation for multiple stent insertion
The wing stent facilitates repeat bile duct cannulation for multiple stent insertion
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翼形支架有助于重复胆管插管以进行多个支架插入
DOI：
10.1055/s-0030-1255989
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发表时间：
2010
期刊：
影响因子：
9.3
通讯作者：
S. Giday
中科院分区：
文献类型：
--
作者：
M. Khashab;Vikesh K. Singh;A. Lennon;S. Giday
塑料胆道支架的最大缺点是通畅率较低[1]，因为它们易于在支架的中心腔内形成生物膜，导致胆汁流动受损[2]。翼形支架（ViaDuct; GI Supply，Camp Hill，Pennsylvania，USA）旨在克服这一问题（●”图1）。翼形支架是一种无腔支架，胆汁可沿沿着外部翼形凹槽流动，理论上可降低闭塞风险（●”图1）[3，4]。计算机模拟研究表明，与传统塑料支架相比，翼形支架提供了更大的流动表面积、更高的流速和更高的流速。一项初步研究报告了在5例恶性胆道梗阻患者中成功使用Thewing支架进行内镜下胆道引流，所有患者在2周时胆红素均显著下降，放射学成像显示胆道扩张消退[3]。对于良性胆管狭窄患者，随着时间的推移，内镜下放置多个支架已被证明是解决狭窄的有效疗法[5]。由于多种原因，放置多个支架在技术上可能具有挑战性，包括第一次支架插入后重复胆道插管失败。如果进行了小的胆道括约肌切开术和/或第一个支架的定位阻止了胆道插管或括约肌切开器的必要成角，则可能发生这种情况。这个问题可以通过使用推送导管将7 Fr或10-Fr翼形支架初始放置到位直到支架远端的不透射线黑色标记在胆道口处可见来克服。随后，通过将导丝推进原位翼支架两翼之间的凹槽并进入近端胆管，实现快速重复胆管插管。然后将传统的塑料支架放置在金属丝上并推进到胆管中。然后可以以类似的方式放置额外的支架（●”图2，●”视频1）。
plastic biliary stents is their short patency rate [1], as they are prone to biofilm buildup within the central lumen of the stent, resulting in impaired bile flow [2]. The wing stent (ViaDuct; GI Supply, Camp Hill, Pennsylvania, USA) was engineered to overcome this problem (●" Fig. 1). The wing stent is a lumenless stent in which bile is channeled along the exterior winged grooves, theoretically reducing the risk of occlusion (●" Fig. 1) [3,4]. Computer modeling studies have shown that the wing stent offers a larger surface area for flow, a higher flow velocity, and increased flow rates compared with conventional plastic stents. A pilot study reported the successful use of thewing stent for endoscopic biliary drainage in five patients with malignant biliary obstruction, all of whom experienced a significant decline in bilirubin at 2 weeks and resolution of biliary dilation by radiologic imaging [3]. The endoscopic placement of multiple stents over time for patients with benign biliary strictures has been shown to be an effective therapy for stricture resolution [5]. The placement of multiple stents can be technically challenging for a number of reasons, including failure of repeat biliary cannulation after the first stent insertion. This can occur if a small biliary sphincterotomy was performed and/or the positioning of the first stent prevents the necessary angulation of the biliary cannula or sphincterotome. This problem can be overcome by initially placing a 7Fr or 10-Fr wing stent into position using a push catheter until the radiopaque black marker at the distal end of the stent is visualized at the biliary orifice. Subsequently, rapid repeat biliary cannulation is achieved by advancing a guidewire into the groove between two wings of the insitu wing stent and into the proximal bile duct. A conventional plastic stent is then placed over the wire and advanced into the bile duct. Additional stents can then be placed in similar manner (●" Fig. 2, ●" Video 1).