In case of bile duct-bowel anastomosis, in which case should the stent be placed? - Examination by biliary regeneration model using artificial bile duct -

Introduction: In case of bile duct-bowel anastomosis, it is not sufficiently studied in what cases the stent should be placed. In this study, a method for diagnosing bile duct stenosis after bile duct injury from a biliary regeneration model using a bioabsorbable bile duct tube (artificial bile duct:ABD) was examined histologically. Method: (Biliary regeneration model) An ABD is implanted so as to bypass the extrahepatic bile duct and duodenum, the bile duct regenerates (Am J Transplant 2005). In this model, in most cases, after the ABD has been absorbed, the bile duct regenerates at the site where the ABD has been implanted. However, in rare cases, the anastomotic portion between the ABD and the natural bile duct may be narrowed. Histological examination of these narrowed bile duct epithelium was performed. Result: There are two types of tissue on the surface of the stenosing bile duct epithelium. A: The bile duct epithelium is detached and only the fibrous connective tissue is observed on the epithelial surface. B: The bile duct epithelium has fallen, but a structure like a small bile duct adherent gland is seen in the lower layer of the epithelial surface. Conclusion: There are two kinds of bile duct narrowing. First, the bile duct narrows due to fibrous tissue without good bile duct regeneration process from the early stage of bile regeneration. Secondly, in the early stage of regeneration of the bile duct, accessory glands of the bile duct was formed, but it was found that there was a state in which the regeneration process did not progress well in the regeneration process of the bile duct epithelium. By the initiation of treatment after bile duct injury, early biopsy and diagnosis of early bile duct epithelial tissue could diagnose early bile duct stricture and make it possible to treat early.