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 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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| 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) | 0.004 | 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".