Outcomes after paclitaxel-coated balloon after iatrogenic biliary injury following single-anastomosis duodeno-ileal bypass: a case report
Bibliographic record
Abstract
Background: Single anastomosis duodeno-ileal bypass (SADI) is becoming more famous in the therapeutic arsenal of bariatric/metabolic issues. The most dreaded postoperative (PO) complications are bleeding, leaks and long-term malabsorption. During the retro-duodenal dissection, a crucial part of this procedure, an iatrogenic injury can occur, due to the presence of important adjacent anatomical structures. The management of a surgery-induced biliary injury, in this specific procedure, is not much described in current literature. Case Description: The patient was 39 years old and had a history of hypertension, obstructive sleep apnea syndrome, with no previous abdominal surgery. She was eligible for bariatric management within our institution, a high-volume center of metabolic and bariatric surgery. First, she underwent a sleeve gastrectomy (SG) [initial body mass index (BMI): 65 kg/m2] with uneventful PO course. One year PO, the BMI stagnates at 55 kg/m2 with remission of the comorbidities, then an SADI was performed. But, due to a complex intraoperative retroduodenal dissection, an iatrogenic perforation of the distal part of the proximal duodenum was deplored and sutured. At 20 days PO, she developed clinical jaundice. A biological cholestasis with conjugated bilirubin without inflammatory syndrome is identified. An abdomino-pelvic tomodensitometry shown dilated intra- and extrahepatic bile ducts upstream of the pancreaticoduodenal junction. Then, we suspected a PO inflammatory stenosis of the common biliary duct secondary to the suture of the previous duodenal perforation. An internal-external transhepatic drain was positioned under radiological control to bypass the obstruction and lift the jaundice. In the following months, the stenosis was dilated by successively increasing drainages, but a residual stenosis persisted. Finally, at 7 months PO, a paclitaxel-coated balloon (anti-angiogenic agents) was placed, allowing the removal of the drain at 9 months PO. At 1 year PO, bilirubinemia is normalized, her excess weight loss (EWL) is 45% and she did not develop any long-term complications. Conclusions: Accessing bile ducts after biliopancreatic diversion, such as SADI, remains challenging. In our case, the paclitaxel-coated balloon was effective against the inflammatory reaction that caused the stenosis of the distal part of the common bile duct. It may be a rescuer to inhibit neointimal hyperplasia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".