{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T10:12:31Z","timestamp":1787393551855,"version":"build-2736575974"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"Asian endoscopy research foundation, Hongkong"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Endoscopic ultrasound-guided biliary drainage (EUS-BD) may be transluminal (choledochoduodenostomy [CDS] and hepaticogastrostomy [HGS]) or transpapillary via an antegrade approach; it is unclear which route is preferred. We conducted a multicenter randomized study comparing the two routes.<\/jats:p>\n                  <jats:p>In this open-label randomized study from five tertiary centers, patients with unresectable malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography were randomized to either EUS-CDS\/HGS or transpapillary stenting. The primary outcome was stent patency (recurrent biliary obstruction), assessed at 1, 3, 6, and 12 months. Analysis was on a per-protocol basis.<\/jats:p>\n                  <jats:p>120 patients (67 males) were recruited (November 2021 to March 2024), with 60 patients in each arm (24 CDS, 36 HGS). The median time to recurrent biliary obstruction was 294 days (95%CI 257.95\u2013330.04) in the transpapillary group and 219 days (95%CI 122.45\u2013315.54) in the transluminal group (P = 0.03). At 3 months, 11\/54 stents (20.4%) were blocked in the transluminal group versus 3\/52 (5.8%) in the transpapillary group (odds ratio [OR] 0.24, 95%CI 0.06\u20130.91; P = 0.04). At 6 months, 21\/54 stents (38.9%) were blocked in the transluminal group versus 11\/52 (21.2%) in the transpapillary group (OR 0.42, 95%CI 0.18\u20130.99; P = 0.04). There were 13 (21.7%) adverse events in the transluminal group (one death), and 8 (13.3%) in the transpapillary group (OR 0.57, 95%CI 0.21\u20131.46; P = 0.33).<\/jats:p>\n                  <jats:p>Transpapillary EUS-BD achieved longer stent patency and a lower rate of recurrent biliary obstruction at 3 and 6 months compared with the transluminal route.<\/jats:p>","DOI":"10.1055\/a-2721-6292","type":"journal-article","created":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T22:30:23Z","timestamp":1760308223000},"page":"493-502","source":"Crossref","is-referenced-by-count":9,"title":["Endoscopic ultrasound-guided transpapillary versus transluminal biliary stenting: randomized comparison of long-term stent patency"],"prefix":"10.1055","volume":"58","clinical-trial-number":[{"clinical-trial-number":"ctri\/2021\/10\/037018","registry":"10.18810\/clinical-trial-registry-india"}],"author":[{"given":"Vinay","family":"Dhir","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Institute of Digestive and Liver Care, SL Raheja Hospital (a Fortis Associate), Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Institute of Digestive and Liver Care, SL Raheja Hospital (a Fortis Associate), Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4497-9209","authenticated-orcid":false,"given":"Sundeep","family":"Lakhtakia","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, AIG Hospitals, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Puri","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Institute of Gastrosciences, Medanta Hospital, Gurugram, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveer","family":"Rai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nonthalee","family":"Pausawasdi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3999-2847","authenticated-orcid":false,"given":"Ryosuke","family":"Tonozuka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5621-6228","authenticated-orcid":false,"given":"Jahangeer","family":"Basha","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, AIG Hospitals, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varayu","family":"Prachayakul","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Kathuria","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Institute of Gastrosciences, Medanta Hospital, Gurugram, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8594-6302","authenticated-orcid":false,"given":"Pankaj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Nageshwar","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, AIG Hospitals, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/j.giec.2022.02.003","article-title":"Endoscopic ultrasound-guided biliary interventions","volume":"32","author":"V Dhir","year":"2022","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1111\/den.12818","article-title":"Endoscopic ultrasonography-guided biliary and pancreatic duct interventions","volume":"29","author":"V Dhir","year":"2017","journal-title":"Dig Endosc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1038\/s41395-018-0122-8","article-title":"EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial","volume":"113","author":"WH Paik","year":"2018","journal-title":"Am J Gastroenterol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.gie.2024.04.019","article-title":"EUS versus ERCP-guided biliary drainage for malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials","volume":"100","author":"EC Barbosa","year":"2024","journal-title":"Gastrointest Endosc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1055\/a-2340-0697","article-title":"Endoscopic ultrasound versus ERCP-guided primary drainage of inoperable malignant distal biliary obstruction: systematic review and meta-analysis of randomized controlled trials","volume":"56","author":"T Khoury","year":"2024","journal-title":"Endoscopy"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.14309\/ajg.0000000000002736","article-title":"Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography-guided biliary drainage as primary approach to malignant distal biliary obstruction: a systematic review and meta-analysis of randomized controlled trials","volume":"12","author":"H Gopakumar","year":"2022","journal-title":"Am J Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1136\/bmj.c332","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"1","author":"KF Schulz","year":"2010","journal-title":"J Pharmacol Pharmacother"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1111\/den.12379","article-title":"TOKYO criteria 2014 for transpapillary biliary stenting","volume":"27","author":"H Isayama","year":"2015","journal-title":"Dig Endosc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A lexicon for endoscopic adverse events: 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Trial)","volume":"165","author":"AY Teoh","year":"2023","journal-title":"Gastroenterology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1055\/a-2134-3537","article-title":"Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study","volume":"56","author":"JA Fritzsche","year":"2024","journal-title":"Endoscopy"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.gie.2024.10.012","article-title":"Optimizing EUS-guided choledochoduodenostomy with lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-IIp): a prospective pilot study","volume":"101","author":"JA Fritzsche","year":"2025","journal-title":"Gastrointest Endosc"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1055\/a-1324-7919","article-title":"Efficacy of 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obstruction","volume":"35","author":"M de Benito Sanz","year":"2021","journal-title":"Surg Endosc"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"4873","DOI":"10.1007\/s00464-021-08435-9","article-title":"Is a coaxial plastic stent within a lumen-apposing metal stent useful for the management of distal malignant biliary obstruction?","volume":"35","author":"A Garcia-Sumalla","year":"2021","journal-title":"Surg Endosc"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/den.14952","article-title":"Comparison of fully versus partially covered metal stents in endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction (with video)","volume":"37","author":"SH Cho","year":"2025","journal-title":"Dig Endosc"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2721-6292.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T22:52:19Z","timestamp":1776898339000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2721-6292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,12]]},"references-count":27,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,4,22]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2721-6292","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10,12]]},"published":{"date-parts":[[2025,10,12]]}}}