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Original article
Treatment of benign biliary leaks with transhepatic placement of coated self-expanding metallic stents
Tratamiento de fugas biliares mediante colocación transparietohepática de endoprótesis metálicas recubiertas
M. Páramoa,
Corresponding author
mparamo@unav.es

Corresponding author.
, P. García-Barquína, M. Carrillob, M. Millor Muruzábala, I. Vivasa, J.I. Bilbaoa
a Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
b Departamento de Radiología, Hospital Morales Meseguer, Murcia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Biliary leaks consist of the extravasation of the bilious content that can cause the formation of free liquid collections in the peritoneal cavity&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1&#44;2</span></a> Small biliary leaks can be managed through placing drainage and antibiotic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> In serious cases&#44; surgery can be the only therapeutic option&#44; but it is not always recommended due to its high morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> If surgical treatment is not possible&#44; the placement of biliary drainage and&#47;or coated and potentially removable biliary stents is an effective alternative&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The percutaneous placement of stents acquires a leading role in those cases in which the duodenum or the common biliary tract cannot be canalized endoscopically&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">5&#44;6</span></a> The goal of our work is to analyze the effectiveness and safety of the percutaneous use of coated self-expandable metallic stents &#40;CSEMS&#41; in the treatment of patients with biliary leaks&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Materials and method&#58;</span> All patients with biliary leaks who had been percutaneously implanted with a CSEMS were reviewed retrospectively&#44; between October 2008 and September 2015&#46; The CSEMS-implantation inclusion criteria were patients with biliary leaks who were not eligible to surgical or endoscopic treatment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 14 patients were included&#44; 11 men and 3 women &#40;mean age&#44; 64&#46;79 years&#59; range&#44; 51&#8211;84 years&#41;&#46; For each patient&#44; age&#44; sex&#44; primary underlying disease&#44; former associated hepatic procedures&#44; clinical success and complications were analyzed&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Biliary leaks</span><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis of biliary leak was established after performing an imaging test&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The leaks were classified as major or minor after taking into consideration the amount of contrast extravasated through fluoroscopy based on Ryan&#39;s classification&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> In some patients&#44; the leak was so severe that is was classified as &#8220;massive&#8221; leak &#40;which required placement of stent directly&#41;&#46; In addition&#44; the number and location of the biliary leaks were evaluated and they were classified as anastomotic &#40;biliodigesive or biliobiliary&#41; and non-anastomotic &#40;of the hepato-choledochal tract or others&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The correct placement of the stent in the biliary tract and the resolution of the biliary leak were regarded as a complete technical success&#46; Those cases in which it was necessary to perform an additional procedure during the first 48<span class="elsevierStyleHsp" style=""></span>h were considered partially successful&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical success was defined when the improvement in the patient&#39;s symptoms and decrease or disappearance of abdominal collection were observed&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Technique</span><p id="par0045" class="elsevierStylePara elsevierViewall">The procedure was performed with general anesthesia and orotracheal intubation in all the cases&#46; All patients were treated prophylactically with broad-spectrum antibiotics &#40;amoxicillin <span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>clavulanic acid&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">First of all&#44; a diagnostic transparieto-hepatic cholangiography was performed&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> The technical difficulty in cases of biliary leaks lies in the fact that the biliary tract is not dilated&#59; even the caliber of the biliary tract becomes so thin due to the continuous extravasation of bile&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Based on the number&#44; type of leak and the result of the transparieto-hepatic cholangiography&#44; the initial procedures varied from patient to patient&#46; In some cases the placement of an external-internal biliary drainage &#40;EIBD&#41; 8<span class="elsevierStyleHsp" style=""></span>F Flexima&#8482; &#40;Boston Scientific&#44; Galway&#44; Ireland&#41; allowed the reduction of the collection size and the performance of a close follow-up to evaluate the disappearance of the leak or&#44; in case it was persistent&#44; the placement of a stent&#46; In cases of massive biliary leaks&#44; the direct placement of one or several Fluency<span class="elsevierStyleSup">&#174;</span> CSEMS was carried out &#40;Bard&#44; Tempe&#44; Arizona&#44; USA&#41; or Wallflex<span class="elsevierStyleSup">&#174;</span> &#40;Boston Scientific&#41;&#46; The number of stents placed was decided based on the number of leaks each patient had&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The diameter of the stents was variable depending on the size and location of the leak&#46; In some cases&#44; the stents were dilated with a balloon once they had been placed&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">When the procedure was finished&#44; another cholangiography was performed to confirm the absence of contrast leak&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">When it comes to the procedure&#44; we studied the number and size of stents&#44; the technical success and whether or not dilation was performed&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Follow-up</span><p id="par0075" class="elsevierStylePara elsevierViewall">The time elapsed from the placement of the first stent to the first time complications such as migration&#44; obstruction or signs of biliary leak &#40;relapse&#41; appeared was considered primary functionality of the stents&#46; To evaluate it&#44; we took into account the time during which the stent worked correctly until the patient&#39;s last clinical checkup or until the patient&#39;s demise&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Relapse was defined as the new appearance of biliary leak after having attained initial technical and clinical success with the placement of a coated stent&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Complications</span><p id="par0085" class="elsevierStylePara elsevierViewall">Both immediate complications &#40;first 30 days&#41; and late complications were divided into majors and minor&#46; Major complications were defined as those that required a therapeutic action that entailed unforeseen increase of hospital stay&#44; and those that led to permanent adverse sequelae or the patient&#39;s death&#46; Minor complications were defined as those that did not need any additional treatment or therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Patients</span><p id="par0090" class="elsevierStylePara elsevierViewall">In 12 patients&#44; biliary leaks were secondary to surgery &#40;6 hepatectomies&#44; 2 live-donor hepatic transplants&#44; 1 hepatorenal transplant and 3 pancreatic surgeries&#41;&#46; One patient showed an arterio-biliary-portal fistula secondary to tumor infiltration&#46; In one patient&#44; the biliary leak was secondary to rupture of the choledochus tract following an endoscopic retrograde cholangiopancreatography &#40;ERCP&#41;&#46; Out of the 6 hepatectomies&#44; the underlying etiologies were 4 cholangiocarcinomas&#44; one hepatocarcinoma and one metastatic colorectal carcinoma&#46; When it comes to pancreatic surgeries the underlying etiologies were two neuroendocrine tumors and one adenocarcinoma &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Percutaneous biliary procedures</span><p id="par0095" class="elsevierStylePara elsevierViewall">In 13 patients percutaneous drainage using 8&#8211;12<span class="elsevierStyleHsp" style=""></span>F Flexima&#8482; &#40;Boston Scientific&#41; was placed in the collection using ultrasound guidance&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Also in 12 patients EIBD were placed prior to the placement of the stents &#40;major leaks&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In two patients the biliary leak was massive and the stents were placed directly&#46; A total of 23 CSEMSs were placed&#58; 21 Fluency<span class="elsevierStyleSup">&#174;</span> type stents and 2 Wallflex<span class="elsevierStyleSup">&#174;</span> type stents&#46; The stents were dilated with balloons in 85&#46;71&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; using Wanda&#8482; catheters &#40;Boston Scientific&#41; ranging between 6 and 10<span class="elsevierStyleHsp" style=""></span>mm in diameter &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The most common location of the biliary leaks was the biliodigestive anastomotic type in 42&#46;85&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; followed by leaks of the bile duct stump in 28&#46;57&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; biliobiliary anastomotic leaks in 14&#46;28&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; one non-anastomotic leak of the hepato-choledochus in 7&#46;14&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and another arterobiliary fistula in 7&#46;14&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Follow-up</span><p id="par0110" class="elsevierStylePara elsevierViewall">The mean follow-up was 375&#46;5 days &#40;range 15&#8211;1920 days&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Total technical success could be achieved in 11 patients &#40;78&#46;6&#37;&#41; and partial success in 2 &#40;14&#46;3&#37;&#41;&#46; No success could be achieved in one &#40;7&#46;2&#37;&#41;&#46; In two patients technical success was partial for different causes&#46; One checkup carried out in one patient &#8211; carrier of 3 CSEMSs twenty four &#40;24&#41; hours after the placement the stent confirmed the stenosis of one of the stents that was dilated with an angioplasty balloon&#46; In another female patient another checkup carried out 48<span class="elsevierStyleHsp" style=""></span>h after the placement of the stent confirmed that the stent had migrated 5<span class="elsevierStyleHsp" style=""></span>mm&#44; so another non-coated Luminex<span class="elsevierStyleSup">&#174;</span> &#40;Bard&#41; stent had to be placed proximally&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Clinical success could be achieved in 13 of the 14 patients&#46; In one patient neither clinical nor technical success could be achieved and since there was a persistent leak in the immediate cholangiographic control another EIBD had to be placed again&#46; In view of the persistence of the leak&#44; a coated stent &#40;Viatorr<span class="elsevierStyleSup">&#174;</span>&#44; Gore&#44; Flagstaff&#44; Arizona&#44; USA&#46;&#41; was placed 10 months after follow-up&#46; With this reintervention the leak was finally sealed&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The primary functionality of the CSEMS was 331 days &#40;range 15&#8211;1920 days&#41;&#46; In 11 patients primary functionality matched their follow-up time&#46; Out of these 11 patients&#44; in 8 patients the follow-up period came to an end due to their demise&#46; One patient was lost to follow-up but two patients are still alive today&#46; In three patients primary functionality and follow-up time did not match due to the presence of complications&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Complications</span><p id="par0130" class="elsevierStylePara elsevierViewall">Nine patients did not have any kinds of complication&#46; In 2 patients immediate major complications were detected&#58; one persistent leak &#40;explained before&#41; and one migration to the intestine a month after implantation which required laparotomy to treat the leak and remove the stent&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Late complications were observed &#40;one of them a major one&#41; in three patients&#46; In one case&#44; the stent partial obstruction could be observed which required cleansing and placement of plastic stents through ERCP&#46; In another patient&#44; the migration of the stent to the intestine was detected incidentally in a control computed tomography &#40;after 277 days&#41; without leak relapse&#46; Lastly while checking one patient&#39;s progression an intrahepatic abscess could be detected one month before his demise but it did not require treatment&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Based on our results&#44; percutaneous treatment of biliary leaks through CSEMS is an effective alternative to surgical and&#47;or endoscopic treatment since it offers a high rate of initial sealing of the leak &#40;technical and clinical success&#41; and long-term high functionality&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Biliary leaks are an uncommon complication that is accompanied by high morbimortality&#46; Its incidence in patients treated with hepatobiliopancreatic surgery ranges between 3&#37; and 10&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">10&#8211;14</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">For cases in which it is not possible to undertake surgical repair of the leak&#44; there are several techniques both endoscopic and transparietohepatic to be able to perform the biliary drainage initially&#46; The most widely accepted technique is based on placing plastic stents through ERCP with which success rates from 82&#37; to 97&#37; can be achieved<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> though some studies have already confirmed that that patency of plastic stents is limited &#40;between 3 and 6 months&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In cases of treatment-resistant biliary leaks or in &#8220;massive&#8221; biliary leaks&#44; it will be necessary to use devices that close the leak effectively and ensure a lasting biliary drainage since sealing the lesion is as important as using a long-lasting method &#40;good functionality&#41;&#46; Both goals can be achieved with the use of CSEMS&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> In cases when the lesion is not accessible through ERCP&#44; the percutaneous approach will be the only alternative&#46; Our study included 14 patients with biliary leaks&#44; in whom CSEMS were placed using the percutaneous approach though there was no chance of removing them endoscopically&#46; The most common used stent was the Fluency<span class="elsevierStyleSup">&#174;</span> stent&#46; In cases when it is possible to access the efferent loop percutaneously toward which the stent is to be implanted it may be interesting to assess the use of removable stents &#40;Wallflex<span class="elsevierStyleSup">&#174;</span>&#41; that could be removed using techniques similar to endoscopic techniques&#46; In 2011&#44; Gwon presented a series of 11 patients who had biliary leaks and who were treated successfully through the percutaneous implantation of CSEMS that were later removed &#40;after 31 days&#41; endoscopically&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> The data obtained from the present series show an excellent functionality &#40;being the leak sealed in 11 out of 14 patients&#41; after an average 331 days &#40;range 15&#8211;1920 days&#41; with a moderate rate of complications&#46; After the placement of partially-coated biliary stents through ERCP&#44; complication rates around 15&#37; have been reported &#40;migration and occlusion of the stent and episodes of cholecystitis&#44; cholangitis and pancreatitis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a> In our study the rate of major complications was greater than that of the endoscopic approach &#40;21&#46;5&#37;&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Our study has some limitations since it is a retrospective analysis&#44; since the sample studied is small &#40;14 patients&#41; and since we do not have a control group&#46; It is&#44; however&#44; the very first one to present the results of the percutaneous placement of CSEMS without planning its removal&#46; Yet despite the fact that there were differences when it comes to the underlying disease and the previously performed surgeries&#44; one homogeneous group when it comes to how to act could be gathered which allows us to draw some conclusions&#46; A good rate of initial sealing was achieved &#40;clinical success&#41; in most patients &#40;13 of 14&#41; as well as good results when it comes to the long-term primary functionality&#59; in fact&#44; in nine patients it matches the follow-up time&#46; In sum the treatment of biliary leaks through the percutaneous placement of CSEMS is effective and has a high technical and clinical success&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical responsibilities</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of people and animals</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that no experiments with human beings or animals have been performed while conducting this investigation&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Data confidentiality</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors confirm that they have followed their center protocol on the publication of data from patients&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors confirm that in this article there are no data from patients&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Authors</span><p id="par0180" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study&#58; JIB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Study Idea&#58; JIB&#44; MP and PGB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Study Design&#58; JIB&#44; MP&#44; PGB&#44; MM and <span class="elsevierStyleSmallCaps">IV</span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Data Mining&#58; JIB&#44; MC&#44; MP&#44; PGB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Data Analysis and Interpretation&#58; JIB&#44; MP&#44; MC&#44; PGB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Statistical Analysis&#58; JIB&#44; MP&#44; PGB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Reference&#58; JIB&#44; MP&#44; MC&#44; PGB&#44; MM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Writing&#58; JIB&#44; MP&#44; MM&#44; PGB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0225" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks&#58; JIB&#44; <span class="elsevierStyleSmallCaps">IV</span>&#44; MP&#44; MC&#44; PGB&#44; MM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Approval of final version&#58; JIB&#44; <span class="elsevierStyleSmallCaps">IV</span>&#44; MP&#44; MC&#44; PGB&#44; MM&#46;</p></li></ul></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest associated with this article whatsoever&#46;</p></span></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the safety and efficacy of percutaneous placement of coated self-expanding metallic stents &#40;SEMS&#41; in patients with biliary leaks&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This ethics committee at our center approved this study&#46; We retrospectively reviewed all coated SEMS placed between October 2008 and September 2015&#46; We analyzed patient-related factors such as the primary underlying disease&#44; prior hepatic procedures&#44; and clinical outcome&#46; We evaluated the location&#44; the number and type of leak &#40;anastomotic or non-anastomotic&#41;&#44; and the characteristics of the interventional procedure &#40;number of stents deployed&#44; location of the stents&#44; technical success&#44; and primary functionality&#41;&#46; We recorded the complications registered&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We studied 14 patients &#40;11 men and 3 women&#41;&#46; The mean follow-up period was 375&#46;5 days &#40;range 15&#8211;1920 days&#41;&#46; Leaks were postsurgical in 12 patients&#46; One patient developed an arteriobilioportal fistula&#46; In another&#44; the biliary leak occurred secondary to the rupture of the common bile duct after ERCP&#46; A total of 23 coated SEMS were placed&#44; including 21 Fluency<span class="elsevierStyleSup">&#174;</span> stents &#40;Bard&#44; Tempe&#44; AZ&#44; USA&#41; and 2 Wallflex<span class="elsevierStyleSup">&#174;</span> stents &#40;Boston Scientific&#44; Galway&#44; Republic of Ireland&#41;&#46; The technical success of the procedure was considered total in 11 &#40;78&#46;6&#37;&#41; patients&#44; partial in 2 &#40;14&#46;3&#37;&#41; patients&#44; and null in 1 &#40;7&#46;2&#37;&#41; patient&#46; The clinical outcome was good in 13 of the 14 patients&#46; The mean period of primary functionality of the coated SEMS was 331 days &#40;range 15&#8211;1920 days&#41;&#46; No major complications were observed in 11 &#40;78&#46;6&#37;&#41; patients&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Percutaneous placement of coated SEMS for the treatment of benign biliary leaks is safe and efficacious&#44; with a high rate of technical and clinical success and a moderate rate of complications&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la seguridad y eficacia en el uso percut&#225;neo de endopr&#243;tesis met&#225;licas autoexpandibles recubiertas &#40;EMAR&#41; en pacientes con fuga biliar&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudio ha sido aprobado por el Comit&#233; de &#201;tica de nuestro centro&#46; Se realiz&#243; una revisi&#243;n retrospectiva de las EMAR colocadas entre octubre de 2008 y septiembre de 2015&#46; Se analizaron la enfermedad primaria subyacente&#44; los procedimientos hep&#225;ticos previos y el &#233;xito cl&#237;nico&#46; Se evalu&#243; la localizaci&#243;n&#44; el n&#250;mero&#44; el tipo de fuga y las caracter&#237;sticas del procedimiento intervencionista &#40;n&#250;mero de pr&#243;tesis empleadas&#44; localizaci&#243;n&#44; &#233;xito t&#233;cnico y funcionalidad primaria&#41;&#46; Se recogieron las complicaciones registradas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 14 pacientes&#46; El seguimiento medio fue de 375&#44;5 d&#237;as &#40;rango de 15-1920 d&#237;as&#41;&#46; En 12 pacientes las fugas biliares fueron posquir&#250;rgicas&#46; Un paciente present&#243; una f&#237;stula arteriobilioportal&#46; En otro paciente&#44; la fuga biliar fue post-CPRE&#46; Se colocaron un total de 23 EMAR&#58; 21 pr&#243;tesis tipo Fluency<span class="elsevierStyleSup">&#174;</span> &#40;Bard&#44; Tempe&#44; Arizona&#44; EE&#46;UU&#46;&#41; y dos pr&#243;tesis tipo Wallflex<span class="elsevierStyleSup">&#174;</span> &#40;Boston Scientific&#44; Galway&#44; Irlanda&#41;&#46; Se consigui&#243; &#233;xito t&#233;cnico total en el 78&#44;6&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; parcial en el 14&#44;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; y no se obtuvo &#233;xito en el 7&#44;2&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Se consigui&#243; &#233;xito cl&#237;nico en 13 de 14 pacientes&#46; La media de funcionalidad primaria de las EMAR fue de 331 d&#237;as &#40;rango de 15-1920 d&#237;as&#41;&#46; Once pacientes no presentaron ninguna complicaci&#243;n mayor&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La colocaci&#243;n percut&#225;nea de EMAR es un m&#233;todo seguro y eficaz en el tratamiento de fugas biliares benignas&#44; con una alta tasa de &#233;xito t&#233;cnico y cl&#237;nico y un nivel moderado de complicaciones&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#225;ramo M&#44; Garc&#237;a-Barqu&#237;n P&#44; Carrillo M&#44; Millor Muruz&#225;bal M&#44; Vivas I&#44; Bilbao JI&#46; Tratamiento de fugas biliares mediante colocaci&#243;n transparietohep&#225;tica de endopr&#243;tesis met&#225;licas recubiertas&#46; Radiolog&#237;a&#46; 2017&#59;59&#58;47&#8211;55&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1451
            "Ancho" => 1500
            "Tamanyo" => 123864
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sixty nine-year-old patient with cholangiocarcinoma treated with radioembolization and left trisectionectomy&#46; In the immediate post-op&#44; abdominal collection was identified in the surgical bed&#46; A&#41; Cholangiography performed through the Kher tube &#40;arrowheads&#41; in which it is possible to observe a major biliary leak &#40;asterisk&#41; located in the bile duct stump&#46; A pigtail percutaneous drainage catheter which had been previously placed is identified within the collection &#40;arrow&#41;&#46; Coils are also observed in the trajectory of the gastroduodenal and suprapyloric arteries associated with a history of radioembolization&#46; B&#41; Double percutaneous approach of right and left biliary ducts&#44; undilated&#44; with introducers 7<span class="elsevierStyleHsp" style=""></span>F in both sides &#40;arrows&#41;&#46; We can see a guide-wire with its distal end in the intestine &#40;arrowheads&#41;&#46; C&#41; Placement of two external-internal biliary drainages&#8211;a right one and a left one&#46; We can see a good contrast passage to the duodenum&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 737
            "Ancho" => 1500
            "Tamanyo" => 97045
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The same patient in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> was followed-up after 60 days&#46; A&#41; Cholangiography through the external&#8211;internal biliary drainage catheters in which the persistence of leak can be seen &#40;asterisk&#41;&#46; B&#41; Placement of two coated self-expandable metallic stents from the right and left biliary ducts to the common hepatic duct&#46; The percutaneous drainage of the abdominal collection persists &#40;arrow&#41;&#46; This patient&#39;s primary functionality was 917 days and no complications happened during the follow-up&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1436
            "Ancho" => 1500
            "Tamanyo" => 225541
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Seventy eight-year-old patient with a history of a neuroendocrine pancreatic tumor who underwent Whipple surgery&#46; In the immediate post-op an abdominal collection was identified in the surgical bed&#46; A&#41; Coronal slice of a computed tomography on portal phase where we can see a great 17<span class="elsevierStyleHsp" style=""></span>cm collection in the pancreatoduodenal anastomosis &#40;asterisk&#41;&#46; B&#41; Transparietohepatic percutaneous cholangiography with right approach where we can see an undilated biliary duct&#46; Presence of contrast extravasation between the biliodigestive connection and the afferent loop stump in the proximity of the Jackson&#8211;Pratt drainage tube &#40;arrow&#41;&#46; C&#41; In view of the findings&#44; new percutaneous access of the left bile duct is performed and a guide wire is advanced toward the intestine &#40;arrowheads&#41;&#46; A massive biliary leak is detected &#40;asterisk&#41;&#46; D&#41; Placement of a left external&#8211;internal biliary drainage &#40;arrow&#41;&#46; A neat good contrast passage to the duodenum can be seen&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 722
            "Ancho" => 1500
            "Tamanyo" => 115024
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Follow-up control was performed on the same patient in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> at 5 days&#46; A&#41; Cholangiography through the external&#8211;internal biliary drainage catheter where persistence of biliary leak can be seen &#40;asterisk&#41;&#46; A decision was made to place a 10<span class="elsevierStyleHsp" style=""></span>mm long coated self-expandable metallic stent&#46; Subsequently&#44; it was dilated with an angioplasty balloon &#40;arrow&#41;&#46; B&#41; The cholangiographic result after 24<span class="elsevierStyleHsp" style=""></span>h was satisfactory&#46; The patient&#39;s primary functionality was 600 days in the absence of complications&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">EIBD&#58; external&#8211;internal biliary drainage&#59; S&#58; success&#59; F&#58; failure&#59; M male&#59; F&#58; female&#59; N&#47;A&#58; non-applicable&#59; NET&#58; neuroendocrine tumor&#59; TX&#58; transplant&#59; HRTX&#58; hepatorenal transplant&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#35;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Underlying disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of biliary leak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location of biliary leak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of leaks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prior hepatic proceedings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technical success&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical success&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cholangiocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biliodigestive anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 right EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 collection drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hepatocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biliodigestive anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 left EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pancreatic NET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Massive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biliodigestive anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Living-donor TX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bibliobiliary anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 right EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bile duct stump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 left EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HRTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Massive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biliodigestive anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gastric carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#237;stula arteriobiliar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Living-donor TX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bibliobiliary anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 right EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cholangiocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bile duct stump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 left EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Post-ERCP perforation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hepato-choledochal non-anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 right EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pancreatic NET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biliodigestive anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 left EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cholangiocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bile duct stump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 right and left EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pancreatic adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bile duct stump&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 left EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cholangiocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Biliodigestive anastomotic type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 right and left EIDB<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 percutaneous drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ERCP&#58; endoscopic retrograde cholangiopancreatography&#59; EIBD&#58; external&#8211;internal biliary drainage&#59; N&#47;A&#58; non-applicable&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#35;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of coated stent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patency &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated hepatic proceedings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leak persistence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Stenosis in the main portal to left portal transition with placement of non-coated stent &#40;Luminex<span class="elsevierStyleSup">&#174;</span>&#44; Bard&#44; 9<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">366&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Persistent small leak with placement of coated stent &#40;Viatorr<span class="elsevierStyleSup">&#174;</span>&#46; 10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1920&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Transjugular intrahepatic portal-systemic shunt with placement of coated stent &#40;Viatorr<span class="elsevierStyleSup">&#174;</span>&#44; 10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mm&#41; and 2 non-coated stents &#40;Wallstant<span class="elsevierStyleSup">&#174;</span>&#44; 10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1920&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">277&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Late migration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">335&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immediate migration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Exploratory laparotomy with placement of 2 Jackson&#8211;Pratt drainages in the collections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hepatic abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Microcoil embolization of the arterial injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Injuries indicative of hepatic abscesses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">329&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Obstruction due to biliary mud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ERCP with placement of plastic stent because of an obstruction due to biliary mud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">487&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Stenosis in the distal area of the stent treated with angioplasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">917&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Thrombosis and right portal stenosis with placement of vascular stent &#40;Luminex<span class="elsevierStyleSup">&#174;</span>&#44; Bard&#44; 8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>60 91<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">917&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Coil embolization of collateral veins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">276&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">276&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Massive acute portal thrombosis with placement of coated stent<br>&#40;Advanta<span class="elsevierStyleSup">&#174;</span>&#44; 9<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Mild migration of left stent treated with placement of non-coated stent &#40;Luminex<span class="elsevierStyleSup">&#174;</span>&#44; Bard&#44; 8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Percutaneous biliary proceedings&#46;</p>"
        ]
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    ]
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interventional radiology in the management of benign biliary stenoses&#44; biliary leaks and fistulas&#58; a pictorial review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Krokidis"
                            1 => "G&#46; Orgera"
                            2 => "M&#46; Rossi"
                            3 => "M&#46; Matteoli"
                            4 => "A&#46; Hatzidakis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13244-012-0200-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Insights Imaging"
                        "fecha" => "2013"
                        "volumen" => "4"
                        "paginaInicial" => "77"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23180415"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;H&#46; Kim"
                            1 => "D&#46;I&#46; Gwon"
                            2 => "G&#46;Y&#46; Ko"
                            3 => "K&#46;B&#46; Sung"
                            4 => "S&#46;K&#46; Lee"
                            5 => "H&#46;K&#46; Yoon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jvir.2011.02.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Interv Radiol"
                        "fecha" => "2011"
                        "volumen" => "22"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21515075"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Minimally invasive management of biliary complications after laparoscopic cholecystectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Zerem"
                            1 => "S&#46; Omerovi&#263;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejim.2009.07.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Intern Med"
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                        "volumen" => "20"
                        "paginaInicial" => "686"
                        "paginaFinal" => "689"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19818287"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous management of anastomotic bile leaks following liver transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Aytekin"
                            1 => "F&#46; Boyvat"
                            2 => "A&#46; Harman"
                            3 => "U&#46; Ozyer"
                            4 => "S&#46; Sevmi&#351;"
                            5 => "M&#46; Haberal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Interv Radiol"
                        "fecha" => "2007"
                        "volumen" => "13"
                        "paginaInicial" => "101"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17562517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of fully covered self-expanding metal stents in benign biliary strictures and bile leaks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Lalezari"
                            1 => "I&#46; Singh"
                            2 => "S&#46; Reicher"
                            3 => "V&#46;E&#46; Eysselein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "World J Gastrointest Endoc"
                        "fecha" => "2013"
                        "volumen" => "5"
                        "paginaInicial" => "332"
                        "paginaFinal" => "339"
                      ]
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                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous interventional therapy of persistent biliary fistulas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46; Yagci"
                            1 => "M&#46; Parildar"
                            2 => "I&#46; Oran"
                            3 => "A&#46; Memis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00261-006-9142-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Abdom Imaging"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "475"
                        "paginaFinal" => "480"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17004135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy&#58; a multicenter review"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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es en pt

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