Flumignan Victor Kalil, Sircili Marcelo Palma, Germano Lígia Garcia, Souza Ana Vitoria Dos Santos, Silva Nicole Fernandes, Fukumasu Newton Kiyoshi, Anjos Raphaela Marques, Otoch Jose Pinhata, Artifon Everson Luiz Almeida
Postgraduate Program in Anesthesiology and Surgical Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Laboratory of Genetics, Butantan Institute and Interunit Graduate Program in Biotechnology, University of São Paulo, São Paulo, Brazil.
Clin Exp Gastroenterol. 2025 Aug 7;18:179-189. doi: 10.2147/CEG.S499088. eCollection 2025.
Plastic biliary stents are an effective treatment for biliary obstruction. Despite being resolutive and accessible, they are known to have a low patency rate, estimated at 3 to 6 months. This can be attributed to the formation of bacterial biofilm, which leads to the luminal obstruction of the stent. The aim of this study is to identify the bacterial composition of biofilms from obstructed plastic biliary stents removed through ERCP.
Obstructed plastic biliary stents were retrieved from patients undergoing ERCP. The stents were fragmented into three segments of 2.0 cm each: proximal, medial, and distal. Gram staining was performed on each fragment, followed by assessment using optical microscopy. Subsequently, 4 µm cross-sections were made of each fragment, with subsequent analysis by confocal microscopy. The material from the inside of the stents was also placed in culture medium and colony-forming units were counted.
Optical microscopy and analysis by confocal microscopy showed a seemingly higher number of bacterial colonies in the distal portion of the stents compared to the proximal and medial regions. A greater presence of bacteria in the distal segments of the stents was confirmed, with growth reaching up to 10, while growth in the proximal and medial segments was only observed up to 10 and 10, respectively. Biochemical identification using Gram staining identified both Gram-positive and Gram-negative species:
The composition of the biofilm in biliary stents confirmed to be polymicrobial. The distal portion of the stents is likely the most frequent site of obstruction. New strategies, such as the development and improvement of plastic stents, should be considered to slow this growth and enhance permeability.
塑料胆管支架是治疗胆管梗阻的有效方法。尽管其具有溶解性且易于使用，但已知其通畅率较低，估计为3至6个月。这可归因于细菌生物膜的形成，导致支架管腔阻塞。本研究的目的是确定通过内镜逆行胰胆管造影（ERCP）取出的阻塞性塑料胆管支架生物膜中的细菌组成。
从接受ERCP的患者中取出阻塞性塑料胆管支架。将支架分成三段，每段2.0厘米：近端、中间和远端。对每个片段进行革兰氏染色，然后用光学显微镜进行评估。随后，对每个片段制作4微米的横截面，随后通过共聚焦显微镜进行分析。还将支架内部的材料置于培养基中并计数菌落形成单位。
光学显微镜和共聚焦显微镜分析显示，与近端和中间区域相比，支架远端的细菌菌落数量似乎更多。证实支架远端部分存在更多细菌，生长可达10，而近端和中间部分的生长分别仅观察到10和10。使用革兰氏染色进行的生化鉴定确定了革兰氏阳性和革兰氏阴性菌种：
胆管支架生物膜的组成被证实为多菌种。支架的远端部分可能是最常见的阻塞部位。应考虑新的策略，如开发和改进塑料支架，以减缓这种生长并提高通透性。
