Prevenzione dell’occlusione delle protesi biliari mediante somministrazione di levofloxacina e acido ursodesossicolico.

Abstract

One of the main advances in biliopancreatic endoscopic therapy has been the ability to palliate patients with biliary obstruction by placement of a stent during ERCP, but this is often complicated by clogging of the stent with subsequent jaundice and/or cholangitis. Stent clogging may be caused by microbiological adhesion and biliary stasis. Therefore, the use of antibiotics and choleretic agents such as levofloxacin and ursodeoxycholic acid has been investigated to see whether they prolong stent patency. Ninety patients with strictures of the biliary tract and untreatable macrolithiasis with endoscopically inserted stents were randomized into two groups: 49 subjects in group 1 (levofloxacin + ursodeoxycholic acid) and 41 in group 2 (ursodeoxycholic acid alone). In the patients in group 1 "stent patency in situ" was 50% longer than in group 2, with a lower incidence of cholangitis and hospital admittance. No adverse pharmacological effects were registered. Treatment with ursodeoxycholic acid and levofloxacin to prevent clogging of biliary stents is recommended as routine practice on the basis of our brief experience. Further trials are needed with rigorous methodology and adequate statistical power, because the perfect biliary stent (inexpensive, easy to insert, and with prolonged patency) does not exist. Prophylactic stent replacement is probably the most prudent strategy to avoid cholangitis, but the optimal time interval is unknown.