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Li Y, Yuan K, Deng C, Tang H, Wang J, Dai X, Zhang B, Sun Z, Ren G, Zhang H, Wang G. Biliary stents for active materials and surface modification: Recent advances and future perspectives. Bioact Mater 2024; 42:587-612. [PMID: 39314863 PMCID: PMC11417150 DOI: 10.1016/j.bioactmat.2024.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/27/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
Demand for biliary stents has expanded with the increasing incidence of biliary disease. The implantation of plastic or self-expandable metal stents can be an effective treatment for biliary strictures. However, these stents are nondegradable and prone to restenosis. Surgical removal or replacement of the nondegradable stents is necessary in cases of disease resolution or restenosis. To overcome these shortcomings, improvements were made to the materials and surfaces used for the stents. First, this paper reviews the advantages and limitations of nondegradable stents. Second, emphasis is placed on biodegradable polymer and biodegradable metal stents, along with functional coatings. This also encompasses tissue engineering & 3D-printed stents were highlighted. Finally, the future perspectives of biliary stents, including pro-epithelialization coatings, multifunctional coated stents, biodegradable shape memory stents, and 4D bioprinting, were discussed.
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Affiliation(s)
- Yuechuan Li
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, National Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Kunshan Yuan
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, National Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Chengchen Deng
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, National Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Hui Tang
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Jinxuan Wang
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, 610500, China
| | - Xiaozhen Dai
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, 610500, China
| | - Bing Zhang
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine (CVIHEM), Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Ziru Sun
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
- College of materials science and engineering, Shandong University of Technology, Zibo, 25500, Shandong, China
| | - Guiying Ren
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
- College of materials science and engineering, Shandong University of Technology, Zibo, 25500, Shandong, China
| | - Haijun Zhang
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, 251100, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, National Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, 610500, China
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine (CVIHEM), Drum Tower Hospital, Nanjing University, Nanjing, China
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Cordista V, Patel S, Lawson R, Lee G, Verheyen M, Westbrook A, Shelton N, Sapkota P, Zabala Valencia I, Gaddam C, Thomas J. Towards a Customizable, SLA 3D-Printed Biliary Stent: Optimizing a Commercially Available Resin and Predicting Stent Behavior with Accurate In Silico Testing. Polymers (Basel) 2024; 16:1978. [PMID: 39065295 PMCID: PMC11280906 DOI: 10.3390/polym16141978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/22/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Inflammation of the bile ducts and surrounding tissues can impede bile flow from the liver into the intestines. If this occurs, a plastic or self-expanding metal (SEM) stent is placed to restore bile drainage. United States (US) Food and Drug Administration (FDA)-approved plastic biliary stents are less expensive than SEMs but have limited patency and can occlude bile flow if placed spanning a duct juncture. Recently, we investigated the effects of variations to post-processing and autoclaving on a commercially available stereolithography (SLA) resin in an effort to produce a suitable material for use in a biliary stent, an FDA Class II medical device. We tested six variations from the manufacturer's recommended post-processing and found that tripling the isopropanol (IPA) wash time to 60 min and reducing the time and temperature of the UV cure to 10 min at 40 °C, followed by a 30 min gravity autoclave cycle, yielded a polymer that was flexible and non-cytotoxic. In turn, we designed and fabricated customizable, SLA 3D-printed polymeric biliary stents that permit bile flow at a duct juncture and can be deployed via catheter. Next, we generated an in silico stent 3-point bend test to predict displacements and peak stresses in the stent designs. We confirmed our simulation accuracy with experimental data from 3-point bend tests on SLA 3D-printed stents. Unfortunately, our 3-point bend test simulation indicates that, when bent to the degree needed for placement via catheter (~30°), the peak stress the stents are predicted to experience would exceed the yield stress of the polymer. Thus, the risk of permanent deformation or damage during placement via catheter to a stent printed and post-processed as we have described would be significant. Moving forward, we will test alternative resins and post-processing parameters that have increased elasticity but would still be compatible with use in a Class II medical device.
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Affiliation(s)
- Victoria Cordista
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
- McKelvey School of Engineering, Washington University, St. Louis, MO 63114, USA
| | - Sagar Patel
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Rebecca Lawson
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Gunhee Lee
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Morgan Verheyen
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Ainsley Westbrook
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Nathan Shelton
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Prakriti Sapkota
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Isabella Zabala Valencia
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Cynthia Gaddam
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
| | - Joanna Thomas
- School of Engineering, Mercer University, Macon, GA 31207, USA; (V.C.); (S.P.); (R.L.); (G.L.); (M.V.); (A.W.); (N.S.); (P.S.); (I.Z.V.); (C.G.)
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Samanta J, Chatterjee A, Dhar J, Nabi Z, Bronswijk M, Aggarwal M, Facciorusso A, Gkolfakis P, Ogura T, Van der Merwe S, Lakhtakia S. Endoscopic ultrasound-guided pancreatic duct drainage: a comprehensive state of the art review. Expert Rev Gastroenterol Hepatol 2024; 18:351-365. [PMID: 39041336 DOI: 10.1080/17474124.2024.2383631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/19/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Endoscopic retrograde pancreatography (ERP) has traditionally been the standard modality for pancreatic endotherapy. However, in certain situations, failure of retrograde ductal access may warrant an alternative modality of drainage. This can occur in various settings like difficult and/or surgically altered anatomy or duodenal obstruction. Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) is a relatively newer addition to the armamentarium for endoscopic access to the PD. AREAS COVERED This comprehensive state-of-art review aims to give an overview of the indications, technical details, different approaches, and outcomes of EUS-PDD, with the latest evidence available in scientific literature. EXPERT OPINION Akin to its biliary drainage counterpart, EUS-PDD enables an EUS-assisted-ERP using rendezvous technique or EUS-guided drainage through transmural stenting. The technique has evolved over the ensuing years with multitude of accessories, approaches, and devices to optimize the outcomes. However, the technical success and adverse events rates need to be further improved. Additionally, it has a steep learning curve with requirements of advanced technical skill and optimum infrastructure back-up. Meticulous patient selection, precise knowledge of ductal anatomy, appropriate approach, and carefully chosen accessories can improve its clinical outcomes.
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Affiliation(s)
- Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhirup Chatterjee
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jahnvi Dhar
- Department of Gastroenterology, Adesh Medical College and Hospital, Kurukshetra, Haryana, India
| | - Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and Imelda General Hospital, Bonheiden, Belgium
| | - Manik Aggarwal
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Antonio Facciorusso
- Department Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece
| | - Takeshi Ogura
- Endoscopy Center, Osaka Medical College, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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