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Nguyen NT, Khan HA, Abdul-Baki K, Choi W, Shroff NK, Akhtar Z, Bhargava P. CT imaging features of bile duct stent complications. Clin Imaging 2023; 103:109986. [PMID: 37742411 DOI: 10.1016/j.clinimag.2023.109986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/29/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
Biliary stents have been widely used to treat both malignant and benign biliary obstruction. Biliary stenting serves as a temporary measure to maintain ductal patency and promote bile drainage. Biliary decompression can help relieve clinical symptoms of pain, obstructive jaundice, pruritis, fat malabsorption, and failure to thrive and prevent disease progression, such as secondary biliary cirrhosis and end-stage liver failure. Endoscopic placement of biliary endoprosthesis is a minimally invasive procedure well tolerated by most patients but is not without problems. Multiple early and late complications have been reported in the literature and Computed Tomography (CT) is the most used modality to assess normal positions and evaluate patients suspected of stent complications. The aim of this article is to provide a review various of biliary stent related complications, as seen on CT. Current literature on risk factors, diagnosis and management is also discussed.
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Affiliation(s)
- Nga T Nguyen
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Hasan A Khan
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Kian Abdul-Baki
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Woongsoon Choi
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Neel K Shroff
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Zahra Akhtar
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America.
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2
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Alkhawaldeh IM, Shattarah O, AlSamhori JF, Abu‐Jeyyab M, Nashwan AJ. Late small bowel perforation from a migrated double plastic biliary stent: A case report and a review of literature of 85 cases from 2000 to 2022. Clin Case Rep 2023; 11:e7425. [PMID: 38028080 PMCID: PMC10658557 DOI: 10.1002/ccr3.7425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message This case highlights the importance of considering stent migration as a possible cause of intestinal perforation and the need for prompt surgical intervention. Abstract Endo-biliary stent displacement is rare but can cause intestinal perforation. An 85-year-old woman with a history of ERCPs and biliary stents experienced stomach pain and vomiting. She was diagnosed with small bowel perforation from migrated stents and underwent emergency laparotomy, bowel resection, and tension-free stapled anastomosis.
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Affiliation(s)
| | - Osama Shattarah
- General Surgery Department, School of MedicineMutah UniversityAl‐KarakJordan
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3
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Zorbas KA, Ashmeade S, Lois W, Farkas DT. Small bowel perforation from a migrated biliary stent: A case report and review of literature. World J Gastrointest Endosc 2021; 13:543-554. [PMID: 34733414 PMCID: PMC8546564 DOI: 10.4253/wjge.v13.i10.543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/10/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents, but fortunately has an incidence of less than 1%. CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, alcoholic liver cirrhosis, portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis. On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention. CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents, with one causing perforation. In addition, we review the relevant literature on migrated stents.
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Affiliation(s)
| | - Shane Ashmeade
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
| | - William Lois
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
| | - Daniel T Farkas
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
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Barranco Castro D, Aparcero López R, Domínguez Amodeo A, Caunedo Álvarez A. Biliary stent migration as a rare cause of ileal perforation. Rev Esp Enferm Dig 2021; 114:54-55. [PMID: 34139849 DOI: 10.17235/reed.2021.8073/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The incidence of biliary stent migration is low, and most cases are asymptomatic, with elimination of the piece by the feces. We report the case of a patient with an ileal perforation secondary to a plastic biliary stent migration. Intestinal perforation due to stent migration is an extremely rare complication, being mostly located at duodenum. Patients with previous surgeries, diverticulosis or abdominal wall hernias have a higher risk of complications in case of prosthetic migration, that is the reason why they require special attention and follow-up.
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5
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Brown D, Naidu J, Thomas R. Bowel perforation: a 'not so rare' complication of biliary stent migration. ANZ J Surg 2021; 91:E784-E786. [PMID: 33949077 DOI: 10.1111/ans.16902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Damien Brown
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Jeevinesh Naidu
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rebecca Thomas
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia
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Morosin T, De Robles MS, Still A. Duodenal diverticulum at the site of the major papilla may be a risk factor for biliary stent migration. J Surg Case Rep 2021; 2021:rjab079. [PMID: 33815756 PMCID: PMC7995517 DOI: 10.1093/jscr/rjab079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Stent migration is a well-documented complication following biliary stent insertion. The majority of cases demonstrate passage through the bowel without incident; however, migration may also result in complications, including bowel obstruction or perforation requiring urgent intervention. Risk factors for stent migration comprise of disease pathology as well as stent characteristics including dimension, material and number. Although duodenal diverticulae has been noted as a risk factor for duodenal perforation or obstruction post stent migration, it has yet to be implicated as a contributor to migration itself. Here, we present an unusual case of ileal obstruction secondary to biliary stent impaction, in which the presence of a duodenal diverticulum may be considered a viable risk factor for stent migration.
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Affiliation(s)
- Tia Morosin
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - M Shella De Robles
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Still
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia
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Ling CR, Chen Y, He CG. Ingested toothpick retrieved through a lumbar approach: a case report. BMC Surg 2020; 20:99. [PMID: 32398146 PMCID: PMC7216533 DOI: 10.1186/s12893-020-00768-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background Ingested toothpick may cause severe complications if there is no intervention timely. Toothpicks that required surgical intervention often retrieved through exploratory laparotomy or laparoscopic exploration surgery under general anesthesia, while, those through lumbar approach have been rarely reported. Herein, authors report a case of ingested toothpick which removed through the lumbar surgical approach under local anesthesia and the patient has gained a considerable recovery. Case presentation A 57-year-old man was admitted to our hospital with distending pain in the right flank for more than 20 days. He had a history of accidental toothpick ingestion. Abdominal computed tomography (CT) scan and Color Doppler Ultrasound of the superficial tissue (right flank pain area) consistently revealed a linear lesion -corresponding to the toothpick- was located at the right flank next to the body surface. Surgery via lumbar approach was then successfully performed to retrieve the toothpick under local anesthesia. The post-procedural course was uneventful, and the patient was discharged on the third day after surgery, no complications were noted at the 18-month follow-up. Conclusion When a foreign body that causes perforation of the digestive tract remains for a relative long time (non-acute stage) and the perforation is close to the body surface, a local anesthesia surgery through the corresponding body surface may be a considerable choice.
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Affiliation(s)
- Chun-Run Ling
- Department of General and Pediatric Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Tao Yuan Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi Chen
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Chun-Gang He
- Department of General and Pediatric Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Tao Yuan Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
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8
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Ip CCK, Hong M. Small bowel perforation from migrated biliary stent: why did it happen? ANZ J Surg 2020; 90:1779-1780. [PMID: 32011769 DOI: 10.1111/ans.15646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher C K Ip
- Department of Surgery (Western Health), The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Hong
- Colorectal and General Surgery Unit, Western Health, Melbourne, Victoria, Australia
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Abstract
The common bile duct stenting has been a common endoscopic procedure practiced worldwide for the treatment of benign or malignant bile duct obstruction. Although the procedure has shown a very low morbidity, it is not free from complications. Stent migration has been a common late complication seen in 10% of cases presenting with various manifestations depending on the site of impaction. Here, we present a rare case of distal stent migration with impaction in the sacral foramina due to perforation through sigmoid diverticula with review of literature.
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Affiliation(s)
| | - Sudip Mandrekar
- Depatment of Surgery, Goa Medical College, Bambolim, Goa, India
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Pulat H, Karakose O, Benzin MF, Benzin S, Cetin R. Small bowel perforation due to fish bone: A case report. Turk J Emerg Med 2016; 15:136-8. [PMID: 27239615 PMCID: PMC4878132 DOI: 10.1016/j.tjem.2015.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 12/30/2022] Open
Abstract
Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen.
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Affiliation(s)
- Huseyin Pulat
- Department of Surgical Oncology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Oktay Karakose
- Department of Surgical Oncology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Mehmet Fatih Benzin
- Department of General Surgery, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Seyma Benzin
- Department of Radiology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Recep Cetin
- Department of Surgical Oncology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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11
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Cheruvu S, Kennedy R, Moshenyat Y, Momen M, Krishnaiah M, Anand S. Biliary stent migration: a brief review of potential complications and possible etiological factors. Am J Ther 2014; 21:e124-9. [PMID: 23508199 DOI: 10.1097/MJT.0b013e3182491dd9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biliary endoprostheses continue to demonstrate their utility and simplicity in daily therapeutic endoscopy. However, the transient nature of these foreign bodies also underscores their potential detrimental effects even after successful deployment. Stent related factors, such as type, length and caliber offer potential avenues to minimize the risk of migration. However, a patient related factor such as the presence of prior abdominal surgeries makes it paramount for endoscopists to ascertain the location of a migrated stent. There is a ripe niche for continued research and development in biodegradable stents.
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12
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Abstract
Perforation of the gastrointestinal system by a foreign body is seldom observed in clinical practice; however, it has great importance because it is preventable and can usually be easily treated. In this case report, we present a young male patient, who mistakenly swallowed a foreign body and presented to the emergency service one day later with acute abdomen. The 23-year-old patient was diagnosed with acute appendicitis and underwent emergency laparotomy. During the operation, a plastic object that perforated the terminal ileum lumen and protruded into the abdominal cavity was identified. Along with appendectomy, the foreign body was removed and the ileum was repaired. The detailed history of the patient revealed that he had mistakenly swallowed something one day before the onset of abdominal pain. The patient was discharged on the postoperative seventh day following an uneventful course.
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Affiliation(s)
- Ruslan Abdullayev
- Department of Anesthesiology and Reanimation, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Mahmut Aslan
- Department of General Surgery, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
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13
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El Maksoud WA. Biliary stent migration causing incarceration and perforation of the ileum in a previously uncomplicated inguinal hernia: Report of a case and review of literature. Hellenic J Surg 2014; 86:47-49. [DOI: 10.1007/s13126-014-0094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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14
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Jones M, George B, Jameson J, Garcea G. Biliary stent migration causing perforation of the caecum and chronic abdominal pain. BMJ Case Rep 2013; 2013:bcr-2013-009124. [PMID: 24022897 DOI: 10.1136/bcr-2013-009124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report a case of biliary stent migration causing perforation of the caecum and presenting as chronic abdominal pain. The case was managed by colonoscopic removal of the stent.
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Marmo R, Rea M, Pecora A, Sansone S, Rotondano G. Small bowel obstruction due to penetrating migrated biliary stent: removal with a clip applicator via double balloon enteroscopy. Dig Liver Dis 2013; 45:783-5. [PMID: 23562455 DOI: 10.1016/j.dld.2013.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 02/15/2013] [Accepted: 02/21/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Riccardo Marmo
- Division of Gastroenterology, Curto Hospital, Polla, Italy.
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17
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Abela JE, Anderson JE, Whalen HR, Mitchell KG. Endo-biliary stents for benign disease: not always benign after all! Clin Pract 2011; 1:e102. [PMID: 24765343 PMCID: PMC3981400 DOI: 10.4081/cp.2011.e102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/18/2011] [Indexed: 12/15/2022] Open
Abstract
This case report describes the presentation, management and treatment of a patient who suffered small bowel perforation due to the migration of his biliary stent which had been inserted for benign disease.
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Affiliation(s)
| | - John E Anderson
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Henry R Whalen
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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Abstract
INTRODUCTION The management of obstructive jaundice resulting from both benign and malignant causes relies heavily on minimally invasive techniques and particularly with the insertion of biliary endoprostheses. Migration of these biliary stents is a well-documented problem and can result in a variety of complications including perforation, intra-abdominal sepsis, fistulae formation, obstruction and appendicitis. METHODS A literature search was performed using PubMed examining case reports, published abstracts and reviews to date (2009). In addition, we report a left groin abscess as a previously unreported complication following migration of a biliary endoprosthesis. FINDINGS Stent migration can lead to serious complications and produce significant morbidity and mortality. Symptomatic patients especially those with other co-morbid abdominal pathologies such as colonic diverticulae, parastomal hernia or abdominal hernias may be at an increased risk of perforation especially when straight plastic stents are used.
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Affiliation(s)
- Atul Bagul
- HPB Department, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK.
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