Pitfalls and promises of bile duct alternatives: A narrative review

Abstract

Biliodigestive anastomosis between the extrahepatic bile duct and the intestine for bile duct disease is a gastrointestinal reconstruction that abolishes duodenal papilla function and frequently causes retrograde cholangitis. This chronic inflammation can cause liver dysfunction, liver abscess, and even bile duct cancer. Although research has been conducted for over 100 years to directly repair bile duct defects with alternatives, no bile duct substitute (BDS) has been developed. This narrative review confirms our understanding of why bile duct alternatives have not been developed and explains the clinical applicability of BDSs in the near future. We searched the PubMed electronic database to identify studies conducted to develop BDSs until December 2021 and identified studies in English. Two independent reviewers reviewed studies on large animals with 8 or more cases. Four types of BDSs prevail: Autologous tissue, non-bioabsorbable material, bioabsorbable material, and others (decellularized tissue, 3D-printed structures, etc. ). In most studies, BDSs failed due to obstruction of the lumen or stenosis of the anastomosis with the native bile duct. BDS has not been developed primarily because control of bile duct wound healing and regeneration has not been elucidated. A BDS expected to be clinically applied in the near future incorporates a bioabsorbable material that allows for regeneration of the bile duct outside the BDS.

Biomechanical Behaviors and Degradation Properties of Multilayered Polymer Scaffolds: The Phase Space Method for Bile Duct Design and Bioengineering

“…Previously, an approach balancing the mechanical and biological compatibility of polymers was used for designing tissue-engineered vessels [ 55 , 114 ]. The principles applied to the creation and clinical application of biomedical products for regenerative medicine are still under development [ 115 ], but in recent years, an increasing volume of papers have been devoted to the problems of tissue engineering [ 116 , 117 , 118 , 119 ]. Indeed, the use of bioabsorbable bile duct substitutes for bile duct regeneration constitutes a promising approach that will be clinically useful in the future [ 119 ].…”

Fabrication of 3D printed PCL/PEG artificial bile ducts as supportive scaffolds to promote regeneration of extrahepatic bile ducts in a canine biliary defect model

“…Therefore, the promotion of defective bile duct regeneration represents an effective approach to addressing biliary tract defects. 8 This highlights the importance of research on artificial bile ducts in the field of biliary surgery.…”