Endoscopic management of occluded metal biliary stents:Metal versus 10F plastic stents

AIM:To compare the efficacy of self-expandable metal stents(SEMSs) with 10F plastic stents(PSs) in the endoscopic management of occluded SEMSs.METHODS:We retrospectively reviewed the medical records of 56 patients who underwent SEMS insertion for palliation of unresectable malignant biliary obstruction between 2000 and 2007 and subsequent endoscopic retrograde biliary drainage(ERBD) with SEMS or PS for initial SEMS occlusion between 2000 and 2008.RESULTS:Subsequent ERBD with SEMS was performed in 29 patients and with PS in 27.The median time to stent occlusion after subsequent ERBD was 186 d in the SEMS group and 101 d in the PS group(P= 0.118).Overall median stent patency was 79 d for the SEMS group and 66 d for the PS group(P = 0.379).The mean number of additional biliary drainage procedures after subsequent ERBD in patients that died(n = 50) during the study period was 2.54 ± 4.12 for the SEMS group and 1.85 ± 1.95 for the PS group(P = 0.457).The mean total cost of additional biliary drainage procedures after the occlusion of subsequent SEMS or PS was $410.04 ± 692.60 for the SEMS group and $630.16 ± 671.63 for the PS group(P = 0.260).Tumor ingrowth as the cause of initial SEMS occlusion was the only factor associated with a shorter time to subsequent stent occlusion(101 d for patients with tumor ingrowth vs 268 d for patients without tumor ingrowth,P = 0.008).CONCLUSION:Subsequent ERBD with PSs offered similar patency and number of additional biliary drainage procedures compared to SEMSs in the management of occluded SEMS.

Probiotics prophylaxis in pyelonephritis infants with normal urinary tracts

Background:Pyelonephritis in infants is considered as a major factor for the formation of renal scar.To prevent recurrent pyelonephritis and renal damage,prophylaxis is extremely important.The aim of this study was to compare the effectiveness of probiotic and antibiotic prophylaxis or no-prophylaxis in infants with pyelonephritis and normal urinary tract.Methods:Altogether 191 infants,who were diagnosed with acute pyelonephritis,proven to have normal urinary tracts and followed up for 6 months on prophylaxis,were retrospectively evaluated.According to the types of prophylaxis,the infants were divided into three groups[probiotics(Lactobacillus species),antibiotics(trimethoprim/sulfamethoxazole,TMP/SMX),and noprophylaxis].The incidence of recurrent urinary tract infection(UTI)during 6 months after the development of pyelonephritis,main causative uropathogens,and its antimicrobial sensitivities were compared.Results:The incidence of recurrent UTI in the probiotic group was 8.2%,which was significantly lower than 20.6%in the no-prophylaxis group(P=0.035)and was not significantly different from 10.0%of the antibiotic group(P=0.532).The significant difference between the probiotic and no-prophylaxis groups was seen only in male infants(P=0.032).The main causative organism of recurrent UTI was Escherichia coli(E.coli),which was not different among the three groups(P=0.305).The resistance rate of E.coli to TMP/SMX was 100%in the antibiotic group,which was significantly higher than 25.0%in the probiotic group and 41.7%in the no-prophylaxis group(P=0.008).Conclusion:Probiotic prophylaxis was more effective in infants with pyelonephritis and normal urinary tract than in those with no-prophylaxis.It could be used as a natural alternative to antibiotic prophylaxis.