{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:09:21Z","timestamp":1790172561180,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To prevent cholangitis in patients with unresectable malignant hilar biliary obstruction (MHBO), we recently implemented scheduled inside plastic stent (IS) exchange every 2\u20134 months. This study aimed to evaluate whether this strategy prevents cholangitis onset and reduces unplanned hospitalizations without increasing adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective single\u2010center study included patients with unresectable MHBO who underwent IS placement between 2011 and 2023. Patients were divided into two groups: those who underwent scheduled IS exchange (scheduled group,\n                      <jats:italic>n<\/jats:italic>\n                      = 12) and those who received on\u2010demand IS exchange (on\u2010demand group,\n                      <jats:italic>n<\/jats:italic>\n                      = 29). We compared unplanned hospitalization duration and number, time from initial IS placement to cholangitis onset, 1\u2010year cholangitis\u2010free rate from initial IS placement, cholangitis severity, adverse events, medical costs, duration of antitumor therapy, and prognosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median duration of unplanned hospitalizations was significantly shorter in the scheduled group compared to the on\u2010demand group (0 days [range: 0\u201383] vs. 38.5 days [0\u2013140],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03). The time from initial IS placement to the onset of cholangitis was also significantly longer in the scheduled group (median 203 days [range: 54\u2013463] vs. 89 days [4\u20131081],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.02). The 1\u2010year cholangitis\u2010free rate was significantly higher in the scheduled group (50%\u00a0vs. 10%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01). No significant differences were found in the number of unplanned hospitalizations, cholangitis severity, adverse events, medical costs, duration of antitumor therapy, or prognosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Scheduled IS exchange delays the onset of cholangitis and reduces the duration of unplanned hospitalizations without increasing adverse events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/deo2.70242","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T18:01:22Z","timestamp":1762797682000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Scheduled Inside Plastic Stent Exchange Prevents Cholangitis and Reduces Unplanned Hospitalization in Patients With Unresectable Malignant Hilar Biliary Obstruction"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7711-5450","authenticated-orcid":false,"given":"Joji","family":"Muramatsu","sequence":"first","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine Sapporo Medical University School of Medicine Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4582-042X","authenticated-orcid":false,"given":"Kazuma","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine Sapporo Medical University School of Medicine Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norito","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine Sapporo Medical University School of Medicine Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5585-0972","authenticated-orcid":false,"given":"Tomohiro","family":"Kubo","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine Sapporo Medical University School of Medicine Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8013-9712","authenticated-orcid":false,"given":"Makoto","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine Sapporo Medical University School of Medicine Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ginji","family":"Omori","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Oji General Hospital Hokkaido 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