{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T10:22:07Z","timestamp":1782382927885,"version":"3.54.5"},"reference-count":17,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background\/Purpose<\/jats:title><jats:p>This study aimed to evaluate the feasibility of endoscopic ultrasound (EUS)\u2010guided antegrade covered stent placement with long duodenal extension (EASL) for malignant distal biliary obstruction (MDBO) with duodenal obstruction (DO) or surgically altered anatomy (SAA) after failed endoscopic retrograde cholangiopancreatography (ERCP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Outcomes were technical and clinical success, reintervention rate, adverse events, stent patency, and overall survival. Inverse probability of treatment weighting (IPTW) and competing\u2010risk analysis were performed to compare with conventional EUS\u2010BD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010five patients (DO, n\u00a0=\u00a018; SAA, n\u00a0=\u00a07) were included. The technical and clinical success rates were 96% and 84%, respectively. Reintervention occurred in two patients (8.3%). Adverse events occurred in six patients (24%; two cholangitis, 16%; four mild postprocedural pancreatitis [24% (n\u00a0=\u00a04\/17) in patients with non\u2010pancreatic cancers]). The median patency was 9.4\u00a0months, and the overall survival was 2.73\u00a0months. After IPTW adjustment, the median patency in the EASL (n\u00a0=\u00a025) and conventional EUS\u2010BD (n\u00a0=\u00a029) were 10.1 and 6.5\u00a0months, respectively (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.018).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>EASL has acceptable clinical outcomes with a low reintervention rate but higher rate of postprocedural pancreatitis in patients with non\u2010pancreatic cancers. Randomized trials comparing EASL and conventional EUS\u2010BD for MDBO with pancreatic cancers and DO\/SAA after failed ERCP are needed to validate our findings.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhbp.1011","type":"journal-article","created":{"date-parts":[[2021,6,12]],"date-time":"2021-06-12T14:37:11Z","timestamp":1623508631000},"page":"1130-1137","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Initial experience of endoscopic ultrasound\u2010guided antegrade covered stent placement with long duodenal extension for malignant distal biliary obstruction (with video)"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8092-2811","authenticated-orcid":false,"given":"Hoonsub","family":"So","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Ulsan University Hospital University of Ulsan College of Medicine Ulsan South 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of Medicine The University of Tokyo Tokyo Japan"},{"name":"Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine The University of Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seon Ok","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics University of Ulsan College of Medicine Asan Medical Center Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do Hyun","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine University of Ulsan College of Medicine Asan Medical Center Seoul South 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