{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:58:49Z","timestamp":1790639929845,"version":"4.1.0"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background and Study Aims The role of endoscopic sphincterotomy (EST) during suprapapillary inside stent placement for unresectable malignant hilar biliary obstruction (MHBO) remains uncertain. We evaluated its association with stent patency and adverse events.<\/jats:p>\n                  <jats:p>Patients and Methods This multicenter retrospective cohort included 376 consecutive patients treated at 8 institutions (2014\u20132024). The primary outcome was time to recurrent biliary obstruction (TRBO). Multivariable Cox regression, 1:1 propensity score matching (PSM), and competing-risk analysis were performed. Patients with prior EST were excluded from index-procedure safety analyses.<\/jats:p>\n                  <jats:p>Results Clinical success was achieved in 315 patients; 244 (77.5%) were in the EST group. TRBO did not differ between the EST and non-EST groups overall (median 170 vs 157 days; p = 0.85), after PSM (196 vs 207 days; p = 0.49), or in adjusted Cox analysis (hazard ratio 1.21, 95% CI 0.77\u20131.90). Competing-risk analysis likewise showed no difference (Gray\u2019s p = 0.45). Among 360 patients without prior EST, PEP occurred in 7.8% versus 11.0% (p = 0.388), PEB in 1.5% versus 0% (p = 0.576), and perforation in 0.4% versus 0% (p = 1.000) in the index EST and non-EST groups, respectively. The single perforation was type III and was classified as mild in severity.<\/jats:p>\n                  <jats:p>Conclusions EST was not associated with longer initial stent patency. These retrospective findings do not support routine EST solely to prolong patency; its potential role in facilitating subsequent transpapillary reinterventions requires prospective evaluation.<\/jats:p>","DOI":"10.1055\/a-2962-1556","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:04:01Z","timestamp":1789686241000},"source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Impact of Sphincterotomy on Suprapapillary Inside Stent Patency in Unresectable Malignant Hilar Biliary Obstruction: A Multicenter Cohort Study"],"prefix":"10.1055","volume":"14","author":[{"given":"So","family":"Nakaji","sequence":"additional","affiliation":[{"name":"Kameda Medical Center, Chiba, Japan","place":["Kamogawa"],"department":["Department of Gastroenterology"]},{"name":"Saga University, Japan","place":["Saga"],"department":["Saga Medical School Faculty of Medicine, Department of Metabolism and Endocrinology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoyoshi","family":"Saito","sequence":"additional","affiliation":[{"name":"Kurume University School of Medicine, Japan","place":["Kurume"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiri","family":"Kita","sequence":"additional","affiliation":[{"name":"Chiba Cancer Center, Chiba Prefecture, Japan","place":["Chiba"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Yoshioka","sequence":"additional","affiliation":[{"name":"Saga-ken Medical Center Koseikan, Japan","place":["Saga"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoyasu","family":"Kan","sequence":"additional","affiliation":[{"name":"Chiba University, Japan","place":["Chiba"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9409-6733","authenticated-orcid":false,"given":"Yusuke","family":"Ishida","sequence":"additional","affiliation":[{"name":"Fukuoka University, Japan","place":["Fukuoka"],"department":["Division of Gastroenterology and Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rintaro","family":"Mikata","sequence":"additional","affiliation":[{"name":"Chiba Prefectural Sawara Hospital, Japan","place":["Katori"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Saga University, Japan","place":["Saga"],"department":["Saga Medical School Faculty of Medicine, Department of Metabolism and Endocrinology, Department of Metabolism and Endocrinology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyasu","family":"Shiratori","sequence":"additional","affiliation":[{"name":"Kameda Medical Center, Chiba, Japan","place":["Kamogawa"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohei","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Kurume University School of Medicine, Japan","place":["Kurume"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-581X","authenticated-orcid":false,"given":"Hiroshi","family":"Ohyama","sequence":"additional","affiliation":[{"name":"Chiba University, Chiba Prefecture, Japan","place":["Chiba"],"department":["Graduate School of Medicine, Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshio","family":"Tsuyuguchi","sequence":"additional","affiliation":[{"name":"Chiba Prefectural Sawara Hospital, Chiba, Japan","place":["Katori"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigenobu","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Kameda Medical Center, Chiba, Japan","place":["Kamogawa"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Nakaya","sequence":"additional","affiliation":[{"name":"Chiba University, Japan","place":["Chiba"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoaki","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"Fukuoka University Faculty of Medicine, Japan","place":["Fukuoka"],"department":["Department of Gastroenterology and Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Saga University, Japan","place":["Saga"],"department":["Saga Medical School Faculty of Medicine, Department of Metabolism and Endocrinology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1111\/j.1572-0241.2006.00764.x","article-title":"Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer","volume":"101","author":"E L Artifon","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1136\/gut.30.8.1132","article-title":"Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice","volume":"30","author":"J R 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A systematic review and meta-analysis","volume":"58","author":"D Fang","year":"2023","journal-title":"Scand J Gastroenterol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"2869","DOI":"10.1007\/s00464-021-08576-x","article-title":"Stent placement above the sphincter of Oddi is a useful option for patients with inoperable malignant hilar biliary obstruction","volume":"36","author":"A Kurita","year":"2022","journal-title":"Surg Endosc"},{"key":"ref17","first-page":"12","article-title":"Suprapapillary biliary stents have longer patency times than Transpapillary stents-a systematic review and meta-analysis","author":"N Kov\u00e1cs","year":"2023","journal-title":"J Clin Med"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S0016-5107(97)70301-8","article-title":"Transpapillary stenting of proximal biliary strictures: does biliary sphincterotomy reduce the risk of postprocedure pancreatitis?","volume":"45","author":"P R 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attempt at consensus","volume":"37","author":"P B Cotton","year":"1991","journal-title":"Gastrointest Endosc"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s00535-004-1535-2","article-title":"Estimation of the stent placement above the intact sphincter of Oddi against malignant bile duct obstruction","volume":"40","author":"N Uchida","year":"2005","journal-title":"J Gastroenterol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"211.e213","DOI":"10.1016\/j.gie.2023.03.007","article-title":"Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: a multicenter, randomized trial","volume":"98","author":"Y Kanno","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"E753","DOI":"10.1055\/a-1135-8437","article-title":"Self-expandable metallic stent placement above the papilla without endoscopic sphincterotomy in patients with distal malignant biliary obstruction","volume":"8","author":"R Takada","year":"2020","journal-title":"Endosc Int Open"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"1394.e1391","DOI":"10.1016\/j.cgh.2021.08.016","article-title":"Risk of pancreatitis following biliary stenting with\/without endoscopic Sphincterotomy: a randomized controlled trial","volume":"20","author":"S Kato","year":"2022","journal-title":"Clin Gastroenterol Hepatol"}],"container-title":["Endoscopy International 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