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Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients

Overview of attention for article published in BMC Gastroenterology, August 2015
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Title
Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients
Published in
BMC Gastroenterology, August 2015
DOI 10.1186/s12876-015-0334-y
Pubmed ID
Authors

Jorge Canena, David Horta, João Coimbra, Liliane Meireles, Pedro Russo, Inês Marques, Leonel Ricardo, Catarina Rodrigues, Tiago Capela, Diana Carvalho, Rafaela Loureiro, António Mateus Dias, Gonçalo Ramos, António Pereira Coutinho, Carlos Romão, Pedro Mota Veiga

Abstract

Biliary leaks have been treated with endoscopic management using different techniques with conflicting results. Furthermore the appropriate rescue therapy for refractory leaks has not been established. We evaluated the clinical effectiveness of initial endotherapy for postcholecystectomy biliary leaks using an homogenous approach (sphincterotomy + placement of a 10-French plastic stent) in a large series of patients as well as the optimal and efficacy of rescue endotherapy for refractory biliary leaks. This was a multicenter, retrospective study of 178 patients who underwent endoscopic management of postcholecystectomy biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore (10-French) plastic stent. Data were collected to analyze the clinical outcomes and technical success, efficacy of the rescue endotherapy and the need for surgery, adverse events and prognostic factors for clinical success of endotherapy. Following endotherapy, closure of the leak was accomplished in 162/178 patients (91.0 %). The multivariate logistic model showed that the type of leak, namely a high-grade biliary leak, was the only independent prognostic factor associated with treatment failure (OR = 26.78; 95 % CI = 6.59-108.83; P < 0.01). The remaining 16 patients were treated with multiple plastic stents (MPSs) with a success rate of 62.5 % (10 patients). The use of fewer than 3 plastic stents (P = 0.023) and a high-grade biliary leak (P = 0.034) were shown to be significant predictors of treatment failure with MPSs in refractory bile leaks. The 6 patients in whom the placement of MPSs failed were retreated with a fully cover self-expandable metallic stent (FCSEMS), resulting in closure of the leak in all cases. Endotherapy of biliary leaks with a combination of biliary sphincterotomy and the placement of a large-bore plastic stent is associated with a high rate of success (90 %). However in our series there were several failures using MPSs as a strategy for rescue endotherapy suggesting that refractory biliary leaks should be treated with FCSEMS especially in patients with high-grade leaks.

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Mendeley readers

The data shown below were compiled from readership statistics for 25 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Portugal 2 8%
Spain 1 4%
Unknown 22 88%

Demographic breakdown

Readers by professional status Count As %
Student > Postgraduate 4 16%
Researcher 4 16%
Student > Bachelor 3 12%
Other 3 12%
Librarian 2 8%
Other 4 16%
Unknown 5 20%
Readers by discipline Count As %
Medicine and Dentistry 17 68%
Psychology 1 4%
Mathematics 1 4%
Unknown 6 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 August 2015.
All research outputs
#3,931,879
of 5,561,865 outputs
Outputs from BMC Gastroenterology
#462
of 631 outputs
Outputs of similar age
#132,567
of 192,234 outputs
Outputs of similar age from BMC Gastroenterology
#38
of 44 outputs
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So far Altmetric has tracked 631 research outputs from this source. They receive a mean Attention Score of 3.3. This one is in the 17th percentile – i.e., 17% of its peers scored the same or lower than it.
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