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Rapid progressive long esophageal stricture caused by gastroesophageal reflux disease after pylorus-preserving pancreatoduodenectomy

Overview of attention for article published in BMC Surgery, April 2016
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Title
Rapid progressive long esophageal stricture caused by gastroesophageal reflux disease after pylorus-preserving pancreatoduodenectomy
Published in
BMC Surgery, April 2016
DOI 10.1186/s12893-016-0137-2
Pubmed ID
Authors

Masahide Fukaya, Tetsuya Abe, Masato Nagino

Abstract

Delayed gastric emptying (DGE) is a major postoperative complication after pylorus-preserving pancreatoduodenectomy (PpPD) and sometimes causes reflux esophagitis. In most cases, this morbidity is controllable by proton-pump inhibitor (PPI) and very rarely results in esophageal stricture. Balloon dilation is usually performed for benign esophageal stricture, and esophagectomy was rarely elected. In the present case, there were two important problems of surgical procedure; how to perform esophageal reconstruction after PpPD and whether to preserve the stomach or not. A 63-year-old man underwent PpPD and Child reconstruction with Braun anastomosis for lower bile duct carcinoma. Two weeks after surgery DGE occurred, and a 10 cm long stricture from middle esophagus to cardia developed one and a half month after surgery in spite of the administration of antacids. Balloon dilation was performed, but perforation occurred. It was recovered with conservative treatment. Even the administration of a proton pump inhibitor (PPI) for approximately five mouths did not improve esophageal stricture. Simultaneous 24-h pH and bilirubin monitoring confirmed that this patient was resistant to PPI. We performed middle-lower esophagectomy with total gastrectomy to prevent gastric acid from injuring reconstructed organ and remnant esophagus through a right thoracoabdominal incision, and we also performed reconstruction with transverse colon, adding Roux-Y anastomosis, to prevent bile reflux to the remnant esophagus. Minor leakage developed during the postoperative course but was soon cured by conservative treatment. The patient started oral intake on the 25th postoperative day (POD) and was discharged on the 34th POD in good condition. Long esophageal stricture after PpPD was successfully treated by middle-lower esophagectomy and total gastrectomy with transverse colon reconstruction through a right thoracoabdominal incision. Conventional PD or SSPPD with Roux-en Y reconstruction rather than PpPD should be selected to reduce the risk of DGE and prevent bile reflux, in performing PD for patients with hiatal hernia or rapid metabolizer CYP2C19 genotype; otherwise, fundoplication such as Nissen and Toupet should be added.

Twitter Demographics

The data shown below were collected from the profiles of 2 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 18 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 18 100%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 3 17%
Other 2 11%
Librarian 2 11%
Researcher 2 11%
Student > Master 2 11%
Other 3 17%
Unknown 4 22%
Readers by discipline Count As %
Medicine and Dentistry 8 44%
Psychology 1 6%
Nursing and Health Professions 1 6%
Unknown 8 44%

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 April 2016.
All research outputs
#4,626,234
of 8,596,331 outputs
Outputs from BMC Surgery
#138
of 340 outputs
Outputs of similar age
#149,331
of 274,376 outputs
Outputs of similar age from BMC Surgery
#12
of 27 outputs
Altmetric has tracked 8,596,331 research outputs across all sources so far. This one is in the 27th percentile – i.e., 27% of other outputs scored the same or lower than it.
So far Altmetric has tracked 340 research outputs from this source. They receive a mean Attention Score of 2.7. This one has gotten more attention than average, scoring higher than 50% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 274,376 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 35th percentile – i.e., 35% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 27 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 51% of its contemporaries.