Hepatobiliary and Pancreatic: Bile duct stricture after cholecystectomy
Bibliographic record
Abstract
There are three common patterns of bile duct injury during cholecystectomy. The first is complete obstruction of the bile duct by a suture or clip that results in post-operative jaundice. The second is damage to the bile duct that results in a localized bile collection or biliary peritonitis. The third is the development of a bile duct stricture that presents as pain, jaundice or cholangitis, usually within 2 years of cholecystectomy. Complete obstruction of the bile duct is managed by further surgery, usually an hepaticojejunostomy. Bile duct leaks are usually managed by endoscopic therapy but there has been debate about the relative merits of endoscopic and operative management for bile duct strictures. Although endoscopic dilatation and endoscopic stents are of temporary benefit, many of these patients have developed recurrent strictures and on-going symptoms. Because of this, surgical management has been recommended for most patients, usually a choledochojejunostomy or hepaticojejunostomy. However, additional endoscopic options include the use of multiple stents over a prolonged period of time or covered metallic stents that can be left in situ for several months and then removed. Unfortunately, these options have not been tested in randomized controlled trials. In the patient illustrated below, a good long-term outcome was achieved with multiple plastic stents. A 48-year-old woman was investigated because of the development of upper abdominal pain and fever, 1 month after laparoscopic cholecystectomy. Liver function tests were abnormal and an abdominal ultrasound study showed mild dilatation of the common hepatic duct and intrahepatic ducts. Endoscopic retrograde cholangiopancreatography showed a stricture, 2 cm in length, in the mid-bile duct (Figure 1). Over a 7 month period, a total of eight plastic stents were sequentially inserted to achieve continuous and progressive dilatation of the stricture. Eight stents have a diameter of approximately 77 F (2.6 cm). The stents were left in situ for 15 months to allow for complete remodelling of the area. There was no apparent stricture after removal of the stents and a repeat ERCP after 10 years showed a normal bile duct (Figure 2). The patient remains asymptomatic. The use of multiple stents for 12-24 months is an option for patients with post-operative biliary strictures and appears to be associated with lower recurrence rates than stenting for shorter periods with one or two stents. Contributed by
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".