{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T19:26:50Z","timestamp":1787081210868,"version":"build-2736575974"},"reference-count":14,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"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":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Maintaining effective biliary drainage is crucial in the era of prolonged chemotherapy for biliary tract cancer (BTC). Plastic stents (PS) are widely used in malignant hilar biliary obstruction (MHBO); nonetheless, the optimal placement (above\u2010 vs. across\u2010the\u2010papilla) remains controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this multicentre retrospective study, 246 patients with unresectable BTC\u2010related MHBO who underwent clinically successful PS placement between April 2016 and August 2024 were analyzed. Patients were classified into the above\u2010the\u2010papilla (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009197) and across\u2010the\u2010papilla (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200949) groups. Baseline imbalances were adjusted using inverse probability of treatment weighting (IPTW) with \u201caverage treatment effect on the treated\u201d. Covariates included age, sex, primary disease, Bismuth classification, cholangitis, prior drainage, and number of stents. The primary outcome was time to recurrent biliary obstruction (TRBO); secondary outcomes included overall survival (OS) and adverse events (AEs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After IPTW adjustment, effective sample sizes were 47.6 (above\u2010the\u2010papilla group) and 49.0 (across\u2010the\u2010papilla group). The median TRBO was significantly longer in the above\u2010the\u2010papilla group (114 vs. 66\u2009days;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), with a hazard ratio of 1.62 (95% confidence interval: 0.97\u20132.70). OS (457 vs. 366\u2009days;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.99) and AE rates were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Above\u2010the\u2010papilla PS placement may prolong stent patency without compromising safety in patients with unresectable BTC\u2010related MHBO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.70104","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T04:25:56Z","timestamp":1773807956000},"page":"649-659","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Above\u2010 Versus Across\u2010The\u2010Papilla Plastic Stent Placement for Malignant Hilar Biliary Obstruction in Unresectable Biliary Tract Cancer: A Multicentre\n                    <scp>IPTW<\/scp>\n                    Analysis"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7038-7955","authenticated-orcid":false,"given":"Shinya","family":"Kawaguchi","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Shizuoka General Hospital  Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2044-5483","authenticated-orcid":false,"given":"Yoshihide","family":"Kanno","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Sendai City Medical Centre  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6637-6997","authenticated-orcid":false,"given":"Junichi","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Iwata City Hospital  Iwata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Seirei Hamamatsu General Hospital  Hamamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuma","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Sapporo Medical University  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4493-9568","authenticated-orcid":false,"given":"Azumi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hamamatsu Medical Centre  Hamamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Iemoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kitaharima Medical Centre  Ono Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8604-8125","authenticated-orcid":false,"given":"Toji","family":"Murabayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Ise Red Cross Hospital  Ise Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1756-3147","authenticated-orcid":false,"given":"Tatsunori","family":"Satoh","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Shizuoka General Hospital  Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4876-446X","authenticated-orcid":false,"given":"Eiji","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science Graduate School of Medical Science Nagoya City University  Nagoya 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