{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:28:28Z","timestamp":1787632108072,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"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:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Covered self\u2010expandable metal stents (CSEMS) are widely used for malignant distal biliary obstruction (MDBO), but cholecystitis, post\u2010endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), stent migration, and recurrent biliary obstruction (RBO) remain clinically important limitations. Multi\u2010hole SEMS (MHSEMS) is a novel CSEMS designed to preserve side\u2010branch drainage and reduce migration. We evaluated MHSEMS compared with conventional CSEMS and explored the potential impact of a newly available 6\u2010mm MHSEMS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single\u2010center study included consecutive patients who underwent initial transpapillary SEMS placement for MDBO between September 2015 and December 2025. Study\u2010I compared MHSEMS versus conventional CSEMS limited to 8\u201310\u00a0mm diameter stents. Study\u2010II included MHSEMS cases only and compared 6\u2010mm versus 8\u201310\u00a0mm MHSEMS. Outcomes included cholecystitis, PEP, RBO, time to RBO (TRBO), and RBO causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Study\u2010I included 148 patients; median follow\u2010up was 80.5\u00a0versus 81.5 days (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.761). Overall cholecystitis was 1\/34\u00a0versus 23\/98 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.008). MHSEMS was independently protective for cholecystitis (odds ratio [OR] 0.0879; 95% confidence interval [95%CI] 0.0111\u20130.696), whereas cystic duct involvement increased risk (OR 3.190; 95%CI 1.160\u20138.720). PEP was 4\/36\u00a0versus 18\/112 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.595). RBO was 1\/36\u00a0versus 28\/112, including migration in 0\u00a0versus 9. TRBO was longer with MHSEMS (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.023). Study\u2010II included 64 MHSEMS cases; PEP was 1\/28\u00a0versus 4\/36 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.375), RBO was 1\/28\u00a0versus 1\/36, and no migration occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MHSEMS was associated with fewer cholecystitis events and migration and longer TRBO versus conventional CSEMS. The potential benefit of 6\u2010mm MHSEMS for reducing PEP remains exploratory and requires confirmation in longer prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/deo2.70411","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:17:12Z","timestamp":1787631432000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes of Multi\u2010Hole Covered Self\u2010Expandable Metal Stents for Malignant Distal Biliary Obstruction: A Retrospective Comparative Study With an Exploratory Evaluation of 6\u2010mm Devices"],"prefix":"10.1002","volume":"7","author":[{"given":"Akinobu","family":"Koiwai","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Miyashita","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana","family":"Inomata","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takehito","family":"Ito","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morihisa","family":"Hirota","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennichi","family":"Satoh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Tohoku Medical and Pharmaceutical University Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1016\/0140-6736(92)92752-2","article-title":"Randomised Trial of Self\u2010expanding Metal Stents versus Polyethylene Stents for Distal Malignant Biliary Obstruction","volume":"340","author":"Davids P. H.","year":"1992","journal-title":"Lancet"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.gie.2015.03.1980","article-title":"Self\u2010expandable Metal Stents versus Plastic Stents for Malignant Biliary Obstruction: A Meta\u2010analysis","volume":"82","author":"Sawas T.","year":"2015","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1136\/gut.2003.018945","article-title":"A Prospective Randomised Study of \u201cCovered\u201d versus \u201cUncovered\u201d Diamond Stents for the Management of Distal Malignant Biliary Obstruction","volume":"53","author":"Isayama H.","year":"2004","journal-title":"Gut"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/j.cgh.2006.06.004","article-title":"Cholecystitis After Metallic Stent Placement in Patients With Malignant Distal Biliary Obstruction","volume":"4","author":"Isayama H.","year":"2006","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.gie.2006.06.022","article-title":"Risk Factors for Cholecystitis After Metal Stent Placement in Malignant Biliary Obstruction","volume":"64","author":"Suk K. T.","year":"2006","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","DOI":"10.1002\/deo2.70014","article-title":"Outcomes of Multi\u2010hole Self\u2010expandable Metal Stents versus Fully Covered Self\u2010expandable Metal Stents for Malignant Distal Biliary Obstruction in Unresectable Pancreatic Cancer","volume":"5","author":"Takeda T.","year":"2025","journal-title":"DEN Open"},{"key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/den.15006","article-title":"Efficacy and Safety of a Novel Multi\u2010hole Fully Covered Self\u2010expandable Metallic Stent for Malignant Distal Biliary Obstruction: Multicenter Retrospective Study","volume":"37","author":"Takahashi S.","year":"2025","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_12_9_1","doi-asserted-by":"crossref","DOI":"10.1002\/deo2.70168","article-title":"Efficacy and Safety of Multihole Partially Covered Self\u2010Expandable Metal Stents for Distal Malignant Biliary Obstruction: A Single\u2010Center Retrospective Study","volume":"6","author":"Matsumoto K.","year":"2026","journal-title":"DEN Open"},{"key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/den.13366","article-title":"Comparison of 8\u2010 and 10\u2010mm Diameter Fully Covered Self\u2010expandable Metal Stents: A Multicenter Prospective Study in Patients With Distal Malignant Biliary Obstruction","volume":"31","author":"Kawashima H.","year":"2019","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1111\/den.14825","article-title":"TOKYO Criteria 2024 for the Assessment of Clinical Outcomes of Endoscopic Biliary Drainage","volume":"36","author":"Isayama H.","year":"2024","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/jhbp.515","article-title":"Tokyo Guidelines 2018: Diagnostic Criteria and Severity Grading of Acute Cholecystitis (With videos)","volume":"25","author":"Yokoe M.","year":"2018","journal-title":"Journal of Hepato\u2010Biliary\u2010Pancreatic Sciences"},{"key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A Lexicon for Endoscopic Adverse Events: Report of an ASGE Workshop","volume":"71","author":"Cotton P. B.","year":"2010","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"744","DOI":"10.5946\/ce.2024.340","article-title":"Efficacy of Multi\u2010hole Self\u2011Expandable Metallic Stents versus Partially Covered Self\u2011Expandable Metallic Stents in Patients With Malignant Distal Biliary Obstruction Caused by Unresectable Pancreatic Cancer: A Retrospective Comparative Cohort Study in Japan","volume":"58","author":"Asada S.","year":"2025","journal-title":"Clinical Endoscopy"},{"key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1067\/mge.2001.117550","article-title":"Risk Factors for Post\u2010ERCP Pancreatitis: A Prospective, Multicenter Study","volume":"54","author":"Freeman M. L.","year":"2001","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"E340","DOI":"10.1055\/a-2039-4316","article-title":"Comparison of 6\u2010mm and 10\u2010mm\u2010diameter, Fully\u2010covered, Self\u2010expandable Metallic Stents for Distal Malignant Biliary Obstruction","volume":"11","author":"Harai S.","year":"2023","journal-title":"Endoscopy International Open"}],"container-title":["DEN Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/deo2.70411","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/deo2.70411","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/deo2.70411","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:17:15Z","timestamp":1787631435000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/deo2.70411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2027,4]]}},"alternative-id":["10.1002\/deo2.70411"],"URL":"https:\/\/doi.org\/10.1002\/deo2.70411","archive":["Portico"],"relation":{},"ISSN":["2692-4609","2692-4609"],"issn-type":[{"value":"2692-4609","type":"print"},{"value":"2692-4609","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"assertion":[{"value":"2026-04-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70411"}}