{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:09:13Z","timestamp":1790172553128,"version":"4.1.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"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:p>Endoscopic retrograde cholangiopancreatography (ERCP) is the standard procedure for biliary drainage; however, access can be challenging in patients with altered anatomy or tumor\u2010related distortion. Endoscopic ultrasound\u2010guided biliary drainage (EUS\u2010BD) is a common alternative, yet it is not always feasible, particularly in patients with prior hepatic resection or severe gastrointestinal deformation. A 67\u2010year\u2010old woman developed obstructive jaundice due to hilar biliary stricture secondary to peritoneal dissemination following colorectal cancer surgery. Initial ERCP achieved side\u2010by\u2010side placement of multi\u2010hole self\u2010expandable metal stents (MHSEMSs), resulting in effective drainage. At recurrence of cholangitis, repeat ERCP failed because of anatomical distortion, and EUS\u2010BD was not feasible due to the patient's prior left hepatectomy. We therefore employed a novel technique: a double\u2010balloon enteroscope overtube was advanced to the duodenum, and a side hole was created 10 cm distal to the insertion port. An ultrathin endoscope was inserted through this side hole, retroflexed in the duodenum, and successfully accessed the papilla. The previously placed MHSEMSs were removed, and new MHSEMSs were deployed using a stent\u2010in\u2010stent method. The patient's cholangitis and associated liver abscesses improved, allowing continuation of systemic chemotherapy. This case demonstrates a novel overtube\u2010assisted ultrathin endoscope technique. The combination of thin delivery systems and an overtube modification may provide a valuable alternative when both conventional ERCP and EUS\u2010BD are not feasible.<\/jats:p>","DOI":"10.1002\/deo2.70253","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T14:32:06Z","timestamp":1764167526000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Technique of Overtube\u2010assisted Ultrathin Endoscopic Biliary Drainage Using Multi\u2010Hole Self\u2010Expandable Metal Stents: A Case Report"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7657-1913","authenticated-orcid":false,"given":"Akinobu","family":"Koiwai","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University  Sendai City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5682-0911","authenticated-orcid":false,"given":"Morihisa","family":"Hirota","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University  Sendai City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University  Sendai City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chihiro","family":"Yunomura","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University  Sendai City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuro","family":"Nakaya","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University  Sendai City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5495-7023","authenticated-orcid":false,"given":"Yuki","family":"Miyashita","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University  Sendai City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana","family":"Inomata","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University  Sendai City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1324-6387","authenticated-orcid":false,"given":"Kennichi","family":"Satoh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University  Sendai City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.631"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314341"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-2106-1967"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.6624-20"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1717-1391"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0901-7343"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1391988"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.5946\/ce.2022.089"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-2584-1901"},{"key":"e_1_2_8_11_1","article-title":"Transpapillary Biliary Drainage Using a Forward\u2010viewing Endoscope for Patients With Distal Malignant Biliary Obstruction and Type I Duodenal Stenosis","volume":"13","author":"Hirata Y.","year":"2025","journal-title":"Endoscopy International Open"}],"container-title":["DEN 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