Is prophylactic ciprofloxacin effective in delaying biliary stent blockage?

Joseph Leung, Eric D. Libby, Douglas W. Morck, Sharon G. McKay, Yan lei Liu, Kan Lam, Merle E. Olson

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Late stent blockage is a major complication of endoscopic stent insertion for malignant obstructive jaundice. Stents block as a result of bacterial infection and biofilm formation. We report a randomized but unblinded study using an animal model to evaluate the effect of prophylactic ciprofloxacin, which selectively suppresses gram-negative bacteria, in an attempt to prolong stent patency. Method: Ten adult cats underwent surgical implantation of 5F polyethylene stents through common bile duct strictures created around the choledochotomy, with the tip of the stent left in the duodenum. Five animals received intravenous ciprofloxacin perioperatively and were then maintained on oral ciprofloxacin 25 mg twice daily. Control cats were not given antibiotics. The animals were sacrificed when signs of biliary obstruction or cholangitis persisted for more than 3 days or at the end of the 16-week study period. Stents were removed and examined for patency. In addition, the stents were cultured to recover the adherent bacteria. Results: All control animals developed stent blockage within 4 weeks. Two ciprofloxacin-treated cats developed stent blockage at 21 and 42 days, respectively, whereas the other 3 cats had patent stents for the entire study period. There was a significant difference between the median stent patency of 112 days for the ciprofloxacin group versus 16 days for the control group (p < 0.02). Bacteriologic cultures showed that the bile and blocked stents from the control group had pre-dominantly gram-negative bacteria, whereas the bile and stents of the ciprofloxacin group had gram-positive and anaerobic bacteria, with an absence of gram-negative bacteria (p < 0.01). Conclusion: Ciprofloxacin prophylaxis eliminates gram-negative bacterial infection in bile and minimizes sludge formation and may have a potential benefit in delaying stent blockage.

Original languageEnglish (US)
Pages (from-to)175-182
Number of pages8
JournalGastrointestinal Endoscopy
Volume52
Issue number2
StatePublished - 2000

Fingerprint

Ciprofloxacin
Stents
Cats
Gram-Negative Bacteria
Bile
Gram-Negative Bacterial Infections
Control Groups
Cholangitis
Obstructive Jaundice
Anaerobic Bacteria
Common Bile Duct
Gram-Positive Bacteria
Polyethylene
Biofilms
Sewage
Duodenum
Bacterial Infections
Pathologic Constriction

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Leung, J., Libby, E. D., Morck, D. W., McKay, S. G., Liu, Y. L., Lam, K., & Olson, M. E. (2000). Is prophylactic ciprofloxacin effective in delaying biliary stent blockage? Gastrointestinal Endoscopy, 52(2), 175-182.

Is prophylactic ciprofloxacin effective in delaying biliary stent blockage? / Leung, Joseph; Libby, Eric D.; Morck, Douglas W.; McKay, Sharon G.; Liu, Yan lei; Lam, Kan; Olson, Merle E.

In: Gastrointestinal Endoscopy, Vol. 52, No. 2, 2000, p. 175-182.

Research output: Contribution to journalArticle

Leung, J, Libby, ED, Morck, DW, McKay, SG, Liu, YL, Lam, K & Olson, ME 2000, 'Is prophylactic ciprofloxacin effective in delaying biliary stent blockage?', Gastrointestinal Endoscopy, vol. 52, no. 2, pp. 175-182.
Leung J, Libby ED, Morck DW, McKay SG, Liu YL, Lam K et al. Is prophylactic ciprofloxacin effective in delaying biliary stent blockage? Gastrointestinal Endoscopy. 2000;52(2):175-182.
Leung, Joseph ; Libby, Eric D. ; Morck, Douglas W. ; McKay, Sharon G. ; Liu, Yan lei ; Lam, Kan ; Olson, Merle E. / Is prophylactic ciprofloxacin effective in delaying biliary stent blockage?. In: Gastrointestinal Endoscopy. 2000 ; Vol. 52, No. 2. pp. 175-182.
@article{6d8c74f86db34b3399e072026e1f8a3d,
title = "Is prophylactic ciprofloxacin effective in delaying biliary stent blockage?",
abstract = "Background: Late stent blockage is a major complication of endoscopic stent insertion for malignant obstructive jaundice. Stents block as a result of bacterial infection and biofilm formation. We report a randomized but unblinded study using an animal model to evaluate the effect of prophylactic ciprofloxacin, which selectively suppresses gram-negative bacteria, in an attempt to prolong stent patency. Method: Ten adult cats underwent surgical implantation of 5F polyethylene stents through common bile duct strictures created around the choledochotomy, with the tip of the stent left in the duodenum. Five animals received intravenous ciprofloxacin perioperatively and were then maintained on oral ciprofloxacin 25 mg twice daily. Control cats were not given antibiotics. The animals were sacrificed when signs of biliary obstruction or cholangitis persisted for more than 3 days or at the end of the 16-week study period. Stents were removed and examined for patency. In addition, the stents were cultured to recover the adherent bacteria. Results: All control animals developed stent blockage within 4 weeks. Two ciprofloxacin-treated cats developed stent blockage at 21 and 42 days, respectively, whereas the other 3 cats had patent stents for the entire study period. There was a significant difference between the median stent patency of 112 days for the ciprofloxacin group versus 16 days for the control group (p < 0.02). Bacteriologic cultures showed that the bile and blocked stents from the control group had pre-dominantly gram-negative bacteria, whereas the bile and stents of the ciprofloxacin group had gram-positive and anaerobic bacteria, with an absence of gram-negative bacteria (p < 0.01). Conclusion: Ciprofloxacin prophylaxis eliminates gram-negative bacterial infection in bile and minimizes sludge formation and may have a potential benefit in delaying stent blockage.",
author = "Joseph Leung and Libby, {Eric D.} and Morck, {Douglas W.} and McKay, {Sharon G.} and Liu, {Yan lei} and Kan Lam and Olson, {Merle E.}",
year = "2000",
language = "English (US)",
volume = "52",
pages = "175--182",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Is prophylactic ciprofloxacin effective in delaying biliary stent blockage?

AU - Leung, Joseph

AU - Libby, Eric D.

AU - Morck, Douglas W.

AU - McKay, Sharon G.

AU - Liu, Yan lei

AU - Lam, Kan

AU - Olson, Merle E.

PY - 2000

Y1 - 2000

N2 - Background: Late stent blockage is a major complication of endoscopic stent insertion for malignant obstructive jaundice. Stents block as a result of bacterial infection and biofilm formation. We report a randomized but unblinded study using an animal model to evaluate the effect of prophylactic ciprofloxacin, which selectively suppresses gram-negative bacteria, in an attempt to prolong stent patency. Method: Ten adult cats underwent surgical implantation of 5F polyethylene stents through common bile duct strictures created around the choledochotomy, with the tip of the stent left in the duodenum. Five animals received intravenous ciprofloxacin perioperatively and were then maintained on oral ciprofloxacin 25 mg twice daily. Control cats were not given antibiotics. The animals were sacrificed when signs of biliary obstruction or cholangitis persisted for more than 3 days or at the end of the 16-week study period. Stents were removed and examined for patency. In addition, the stents were cultured to recover the adherent bacteria. Results: All control animals developed stent blockage within 4 weeks. Two ciprofloxacin-treated cats developed stent blockage at 21 and 42 days, respectively, whereas the other 3 cats had patent stents for the entire study period. There was a significant difference between the median stent patency of 112 days for the ciprofloxacin group versus 16 days for the control group (p < 0.02). Bacteriologic cultures showed that the bile and blocked stents from the control group had pre-dominantly gram-negative bacteria, whereas the bile and stents of the ciprofloxacin group had gram-positive and anaerobic bacteria, with an absence of gram-negative bacteria (p < 0.01). Conclusion: Ciprofloxacin prophylaxis eliminates gram-negative bacterial infection in bile and minimizes sludge formation and may have a potential benefit in delaying stent blockage.

AB - Background: Late stent blockage is a major complication of endoscopic stent insertion for malignant obstructive jaundice. Stents block as a result of bacterial infection and biofilm formation. We report a randomized but unblinded study using an animal model to evaluate the effect of prophylactic ciprofloxacin, which selectively suppresses gram-negative bacteria, in an attempt to prolong stent patency. Method: Ten adult cats underwent surgical implantation of 5F polyethylene stents through common bile duct strictures created around the choledochotomy, with the tip of the stent left in the duodenum. Five animals received intravenous ciprofloxacin perioperatively and were then maintained on oral ciprofloxacin 25 mg twice daily. Control cats were not given antibiotics. The animals were sacrificed when signs of biliary obstruction or cholangitis persisted for more than 3 days or at the end of the 16-week study period. Stents were removed and examined for patency. In addition, the stents were cultured to recover the adherent bacteria. Results: All control animals developed stent blockage within 4 weeks. Two ciprofloxacin-treated cats developed stent blockage at 21 and 42 days, respectively, whereas the other 3 cats had patent stents for the entire study period. There was a significant difference between the median stent patency of 112 days for the ciprofloxacin group versus 16 days for the control group (p < 0.02). Bacteriologic cultures showed that the bile and blocked stents from the control group had pre-dominantly gram-negative bacteria, whereas the bile and stents of the ciprofloxacin group had gram-positive and anaerobic bacteria, with an absence of gram-negative bacteria (p < 0.01). Conclusion: Ciprofloxacin prophylaxis eliminates gram-negative bacterial infection in bile and minimizes sludge formation and may have a potential benefit in delaying stent blockage.

UR - http://www.scopus.com/inward/record.url?scp=0033847218&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033847218&partnerID=8YFLogxK

M3 - Article

C2 - 10922087

AN - SCOPUS:0033847218

VL - 52

SP - 175

EP - 182

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 2

ER -