{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:56:19Z","timestamp":1784249779743,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T00:00:00Z","timestamp":1673222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The usefulness of duckbill\u2010type anti\u2010reflux metal stent (DMS) in self\u2010expandable metal stent\u2010na\u00efve pancreatic cancer (PC) patients has not been well\u2010studied. This study aimed to evaluate the efficacy and safety of DMS in such patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed consecutive patients with unresectable PC who received a covered metal stent (CMS) as the initial self\u2010expandable metal stent at our institution. Technical success, functional success, causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and reintervention rates were compared between DMS and conventional CMS (c\u2010CMS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 69 patients were included (DMS: 28, c\u2010CMS: 41). Technical success, functional success, and AEs were similar between groups. Tumor ingrowth was more common in the DMS group (18% vs. 0%, <jats:italic>p<\/jats:italic> = 0.009), while non\u2010occlusion cholangitis tended to be more common in the c\u2010CMS group (0% vs. 15%, <jats:italic>p<\/jats:italic> = 0.074). Median time to RBO was similar between groups (276 vs. 273 days, <jats:italic>p<\/jats:italic> = 0.915). The anti\u2010reflux valve of DMS was found torn in 56% of patients. Endoscopic reintervention was successful in all cases, despite failed stent removal in 88% of patients in the DMS group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>DMS was not associated with longer time to RBO compared to c\u2010CMS in self\u2010expandable metal stent\u2010na\u00efve patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/deo2.205","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T17:52:39Z","timestamp":1673286759000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The efficacy and safety of a duckbill\u2010type anti\u2010reflux metal stent as the initial metal stent for distal malignant biliary obstruction in unresectable pancreatic cancer"],"prefix":"10.1002","volume":"3","author":[{"given":"Tsuyoshi","family":"Takeda","sequence":"first","affiliation":[{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic Medicine Cancer Institute Hospital of Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic Medicine Cancer Institute Hospital of Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic Medicine Cancer Institute Hospital of Japanese Foundation for Cancer Research  Tokyo Japan"},{"name":"Department of Internal medicine Division of Gastroenterology and Hepatology Toho University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic Medicine Cancer Institute Hospital of Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Mie","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic Medicine Cancer Institute Hospital of Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic Medicine Cancer Institute Hospital of Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiyoshi","family":"Kasuga","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic Medicine Cancer Institute Hospital of Japanese Foundation for Cancer Research  Tokyo 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