Kim Sang Hoon, Oh Chi Hyuk, Lee Jae Min, Choi Seong Ji, Choi Hyuk Soon, Kim Eun Sun, Keum Bora, Jeen Yoon Tae, Chun Hoon Jai, Lee Hong Sik, Kim Chang Duck
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2020 Apr;99(16):e19750. doi: 10.1097/MD.0000000000019750.
Biliary drainage is essential to resolve jaundice in patients with malignant biliary obstruction. Recently, a biliary self-expandable metal stent (SEMS) with an antireflux valve was developed to prevent enteric-biliary reflux. Its antireflux valve was made of expanded polytetrafluoroethylene (ePTFE), a biostable and biocompatible material. Changes of the ePTFE membrane of medical devices are rarely reported in clinical practice.
A 59-year-old woman was admitted with a complaint of jaundice. Around 1 month before, she underwent endoscopic biliary stenting using a SEMS with an antireflux valve.
Acute cholangitis due to stent clogging was detected on abdominal computed tomography.
Endoscopic retrograde cholangiopancreatography and removal of the SEMS with deformity were performed.
The obstructive jaundice was rapidly resolved after the removal of the clogged stent.
Although the ePTFE membrane is widely used to make medical devices, unexpected changes could occur after the membrane is exposed to bile juice in the duodenum. When performing biliary stenting using a SEMS with an antireflux valve, both the risk of early malfunction and the benefit of the antireflux effect should be considered.
胆管引流对于解决恶性胆管梗阻患者的黄疸至关重要。最近，一种带有抗反流瓣膜的胆管自膨式金属支架（SEMS）被研发出来以防止肠胆反流。其抗反流瓣膜由膨体聚四氟乙烯（ePTFE）制成，这是一种生物稳定且生物相容的材料。在临床实践中，医疗设备的ePTFE膜的变化鲜有报道。
一名59岁女性因黄疸主诉入院。大约1个月前，她接受了使用带有抗反流瓣膜的SEMS的内镜胆管支架置入术。
腹部计算机断层扫描检测到因支架堵塞导致的急性胆管炎。
进行了内镜逆行胰胆管造影术并取出了有畸形的SEMS。
取出堵塞的支架后，梗阻性黄疸迅速得到缓解。
尽管ePTFE膜被广泛用于制造医疗设备，但在该膜暴露于十二指肠内的胆汁后可能会发生意想不到的变化。在使用带有抗反流瓣膜的SEMS进行胆管支架置入时，应同时考虑早期故障的风险和抗反流效果的益处。
