Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3370
Peer-review started: April 25, 2019
First decision: May 16, 2019
Revised: May 26, 2019
Accepted: May 31, 2019
Article in press: June 1, 2019
Published online: July 14, 2019
The treatment of difficult common bile duct stones (CBDS) remains a big challenge around the world and there is no consensus on the management of difficult CBDS.
In our previous studies, we have developed a drug-eluting plastic stent (PS) which is able to release disodium ethylene diamine tetraacetic acid (EDTA) and sodium cholate (SC), and the stent has been proved to effectively dissolve CBDS ex vivo and in a live porcine CBDS model. However, there are several shortcomings in our previous version, thus we aimed to modify our stone-dissolving stents in this study.
This study aimed to manufacture a drug-eluting metal stent, which can achieve controlled release of stone-dissolving agents and speed up the dissolution of CBDS, thus providing a promising alternative for the management of difficult CBDS.
In this study, three different methods were used to manufacture the drug-eluting stents. The drug-release behavior and stone-dissolving efficacy of these stents was evaluated in vitro to sort out the best manufacturing method. And the selected stone-dissolving stents were further put into porcine CBD to evaluate their biosecurity.
We found that the stent manufactured by dip coating combined with electrospinning was characterized by sustainable drug release, better stone-dissolving efficacy, and good biosecurity. However, we failed to establish the CBDS model in miniature pigs and the disintegration of stone caused by mechanical friction between fully covered self-expanding metal stent (FCSEMS) and stone could not be fully evaluated.
The novel SC and EDTA-eluting FCSEMS is efficient in diminishing CBDS in vitro and is characterized by good biosecurity. The idea of delivering stone-dissolving agents to the location of CBDS via biliary stent is feasible. When conventional endoscopic techniques fail to remove difficult CBDS, SC and EDTA-eluting FCSEMS implantation may be considered a promising alternative.
In the future research, a live porcine CBDS model needs to be established so that the disintegration of stone caused by mechanical friction between FCSEMS and stone could be fully evaluated. And we can compare which stent works better in disintegrating CBDS, PS, or FCSEMS.