| AIM:To investigate the mechanism of the blocking of plastic biliary stent placed endoscopically in the treatment of benign and malignant biliary stricture.METHEODS:The experimental subjects are eighteen patients who underwent biliary plastic stents blocking after endoscopic placement and received a second therapeutic ERCP. After the obstructed plastic stent removed via ERCP, the blockage extracted from the blocked stent were made into suspended matter in 10ml normal saline in a sterile dish, of which 5ml was injected into an aerobic bottle and another 5ml into an anaerobic bottle for bacterial culture and drug susceptibility. Before cholangiography,20ml bile was extracted with a sterile syringe,10ml of which was for bacterial culture and the others for bile smear. In addition, four patients with cholangitis were performed blood culture.RESULTS:The blockage scattered at different sites of stents and they were mainly composed by brown, soft and heterogeneous material when observed with naked eyes after being removed from the explanted plastic biliary stents. Three kinds of bacteria (aerobic bacteria, anaerobic bacteria and fungi) reproduced in the culture. For the same patient's bacteria culture, all kinds of bacteria in bile or in blood were included in obstruction. Among the obstruction culture, fourteen of eighteen patients had Escherichia coli (14/18,77.8%) accounted for56 (25%) of the total number of bacteria, which was sensitive to imipenem and cefoperazone. During the bile smears, there were five patients examined deposition of bilirubin calcium granules under observation of microscope, and there were Escherichia coli in the obstruction or bile culture.CONCLUSION:Our study shows that the mechanism of the plastic biliary stent obstruction is mainly attributed to bilirubin calcium siltation and Escherichia coli adhesion, and both have synergistic to stent occlusion.
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