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Etude expérimentale des concrétions responsables de I’obstruction des endoprothèses biliaires

Investigation on the incrustation and obstruction of bile duct endoprostheses

  • Published:
Acta Endoscopica

Résumé

22 endoprothèses biliaires provenant de 16 patients consècutifs porteurs de lésions malignes des voies biliaires, ont été l’objet d’une recherche de cristaux et de matériel amorphe (boue biliaire) adhérant à la paroi interne de I’endoprothèse. Des dèpôts ≪ boueux ≫ ont été retrouvés dans environ 70 % des cas et ďaprès les données cliniques, étaient responsables d’une perte totale ou partielle de la valeur fonctionnelle de l’endoprothèse.

Du bilirubinate de calcium, des sels calciques d’acides gras et des protéines, constituaient les principaux composants du matériel obstructif, dont la coalescence s’est constituée environ quatre semaines ou plus après la mise en place de la prothèse.

Le stade précoce de l’incrustation se caractérise par la formation d’une fine couche protéique recouvrant la paroi de l’endoprothèse. Cette couche joue vraisemblablement un rôle adhésif et favorise ainsi la rétention de micro-cristaux ou d’un matériel pigmentaire amorphe.

Le fait que la boue revêtant l’endoprothèse, comporte la présence du bilirubinate de calcium, d’acides gras libres et de leurs sels calciques et en outre, de sels biliaires non conjugués, plaide pour un rôle étiologique d’une infection bactérienne. Le rôle pathogénique des couches protéiques et des plots riches en protéines n’a jusqu’à présent pas été établi.

Summary

22 bile duct endoprostheses deriving from 16 consecutive patients with malignant biliary obstructions were investigated for crystals and amorphous material (biliary sludge) adhering to the inner wall of the endoprostheses. Muddy deposits were found in about 70 % of the cases studied, leading to a partial or even total loss of endoprosthesis function as revealed by clinical data.

Calcium bilirubinate, fatty acid calcium salts and proteins were the main components responsible for clogging, a process which was found to take generally 4 weeks or more.

The early stage of incrustation was observed to be characterized by the formation of a thin protein layer covering the wall of the endoprosthesis. This layer is likely to have an adhesive function, thus promoting the retention of small crystals and amorphous pigment material.

The presence of calcium bilirubinate, free fatty acids and their calcium salts and, additionally, unconjugated bile acids in endoprosthesis sludge strongly suggests that bacterial infection is of etiological significance. The pathogenesis of protein layers and protein-rich plugs has yet to be established.

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Authors and Affiliations

  1. Institute of Medical Physics, University Münster, Münster

    U. Wosiewitz

  2. Reinhardt-Nieter-Hospital, Wilhelmshaven

    B. Schrameyer

  3. Institute of Physiology, University Münster, Münster

    E. Zimmermann

Authors
  1. U. Wosiewitz
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  2. B. Schrameyer
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  3. E. Zimmermann
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Additional information

Tirés à part: Dr U. Wosiewitz, University Münster, Inst. med. Physik, Schmeddingstr’50, D-4400 Münster, F. R. G.

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Wosiewitz, U., Schrameyer, B. & Zimmermann, E. Etude expérimentale des concrétions responsables de I’obstruction des endoprothèses biliaires. Acta Endosc 15, 395–402 (1985). https://doi.org/10.1007/BF02966209

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  • DOI: https://doi.org/10.1007/BF02966209

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