{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:44:31Z","timestamp":1785735871837,"version":"3.56.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"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":[[2027,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Concurrent malignant biliary obstruction (MBO) and type I duodenal stenosis represent a technically demanding scenario, as luminal narrowing frequently precludes passage of a standard side\u2010viewing duodenoscope and limits conventional transpapillary drainage. Although endoscopic ultrasound\u2010guided biliary drainage and percutaneous transhepatic biliary drainage are established alternative approaches, transpapillary drainage remains desirable when papillary access is achievable. We report a 66\u2010year\u2010old woman with stage IV pancreatic cancer who presented with obstructive jaundice and tumor\u2010related type I duodenal stenosis (i.e., obstruction proximal to the papilla). A side\u2010viewing duodenoscope failed to traverse the stenosis; however, a standard forward\u2010viewing endoscope (GIF\u2010Q260J) successfully reached the major papilla. Selective biliary cannulation was achieved, and a covered multihole self\u2010expandable metal stent (SEMS) (HANAROSTENT Biliary Multihole Benefit) was deployed across the distal biliary stricture using an ultra\u2010slim 5.9\u2010Fr delivery system compatible with the 3.2\u2010mm working channel. Stent placement was technically successful without adverse events, resulting in prompt resolution of cholangitis and enabling the initiation of second\u2010line chemotherapy. This case highlights a practical and reproducible strategy that expands the therapeutic capability of standard forward\u2010viewing endoscopes. The combination of a slim delivery system and covered multihole SEMS may provide a physiological alternative to non\u2010transpapillary drainage in selected patients with MBO and advanced type I duodenal stenosis.<\/jats:p>","DOI":"10.1002\/deo2.70392","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:54:38Z","timestamp":1785732878000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transpapillary Placement of a Multihole Covered Metal Stent Using a 5.9\u2010Fr Delivery System Through a Forward\u2010viewing Endoscope in Malignant Biliary Obstruction With Type I Duodenal Stenosis"],"prefix":"10.1002","volume":"7","author":[{"given":"Kengo","family":"Matsumoto","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Okabe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Osugi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Doi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Fukui","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsutomu","family":"Nishida","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Toyonaka Municipal Hospital  Toyonaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.5946\/ce.2018.102"},{"key":"e_1_2_9_3_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"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1055\/a-2580-1316","article-title":"Endoscopic Ultrasound\u2010guided Choledochoduodenostomy Results in Fewer Complications Than Percutaneous Drainage Following Failed ERCP in Malignant Distal Biliary Obstruction","volume":"57","author":"Jong M. J. P.","year":"2025","journal-title":"Endoscopy"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.12729"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-2158-7776"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"2828","DOI":"10.3748\/wjg.v16.i22.2828","article-title":"Treating Bilio\u2010duodenal Obstruction: Combining New Endoscopic Technique With 6 Fr Stent Introducer","volume":"16","author":"Maetani I.","year":"2010","journal-title":"World Journal of Gastroenterology"},{"key":"e_1_2_9_8_1","first-page":"156","article-title":"Comparison of the Clinical Impact of Endoscopic Ultrasound\u2010guided Choledochoduodenostomy and Hepaticogastrostomy for Bile Duct Obstruction With Duodenal Obstruction","volume":"48","author":"Ogura T.","year":"2016","journal-title":"Endoscopy"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2024.03.027"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/deo2.70168"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.15006"}],"container-title":["DEN Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/deo2.70392","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/deo2.70392","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/deo2.70392","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:54:39Z","timestamp":1785732879000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/deo2.70392"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,2]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2027,4]]}},"alternative-id":["10.1002\/deo2.70392"],"URL":"https:\/\/doi.org\/10.1002\/deo2.70392","archive":["Portico"],"relation":{},"ISSN":["2692-4609","2692-4609"],"issn-type":[{"value":"2692-4609","type":"print"},{"value":"2692-4609","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,2]]},"assertion":[{"value":"2026-03-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70392"}}