{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:52:35Z","timestamp":1792785155878,"version":"4.5.0"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Japan Science and Technology Agency (JST) Moonshot R&D","award":["JPMJMS2022"],"award-info":[{"award-number":["JPMJMS2022"]}],"id":[{"id":"https:\/\/ror.org\/00097mb19","id-type":"ROR","asserted-by":"crossref"}]},{"name":"JSPS KAKENHI","award":["24K11070,25K02640"],"award-info":[{"award-number":["24K11070,25K02640"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"abstract":"<jats:p>Background and study aims\nSelf-expandable metal stents (SEMS) are widely used for malignant hilar biliary obstruction (MHBO), but whether they improve long-term drainage over plastic stents (PS) is uncertain. As chemotherapy prolongs survival, biliary drainage must be sustained across the remaining disease course. We compared failure of intended lifelong biliary drainage (LDF) between PS-based management and SEMS exposure using a causal inference framework.\nPatients and methods\nWe retrospectively studied 608 consecutive patients who underwent initial endoscopic drainage for unresectable MHBO at 22 Japanese tertiary centers between January 2020 and March 2024. SEMS use was modeled as a time-varying, irreversible exposure. A marginal structural model with stabilized inverse probability of treatment and censoring weights estimated the adjusted odds ratio (OR) for LDF, defined as the point at which drainage could no longer be maintained by any endoscopic, EUS-guided, or percutaneous approach.\nResults\nOver a median follow-up of 184 days, 130 patients (21.4%) had LDF and 384 (63.2%) died. SEMS exposure was associated with higher odds of LDF (adjusted OR, 1.87; 95% CI, 1.28\u20132.73; P = 0.001), consistent across sensitivity analyses (OR range, 1.75\u20132.53). The association strengthened from 1.79 at 90 days to 2.93 at 450 days. Cumulative costs were higher in an exploratory analysis.\nConclusions\nSEMS exposure was associated with higher odds of LDF and higher costs than PS-based management. These findings are hypothesis-generating, and prospective studies are needed to determine whether routine first-line SEMS use should be reconsidered when biliary drainage is intended to last across the remaining disease course.<\/jats:p>","DOI":"10.1055\/a-2964-4838","type":"journal-article","created":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T22:30:25Z","timestamp":1790548225000},"source":"Crossref","is-referenced-by-count":0,"title":["Plastic Stent-Based Management Versus Metal Stent Exposure for Lifelong Biliary Drainage in Unresectable Malignant Hilar Biliary Obstruction"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2138-1207","authenticated-orcid":false,"given":"Atsuhiro","family":"Masuda","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine, Japan","place":["Kobe"],"department":["Division of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9202-7643","authenticated-orcid":false,"given":"Takashi","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine, Japan","place":["Kobe"],"department":["Division of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7308-4311","authenticated-orcid":false,"given":"Mamoru","family":"Takenaka","sequence":"additional","affiliation":[{"name":"Kindai University Faculty of Medicine, Japan","place":["Osaka-Sayama"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1220-6546","authenticated-orcid":false,"given":"Tomoaki","family":"Matsumori","sequence":"additional","affiliation":[{"name":"Kyoto University Graduate School of Medicine, Osaka Prefecture, Japan","place":["Takatsuki"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2916-6568","authenticated-orcid":false,"given":"Takeshi","family":"Ogura","sequence":"additional","affiliation":[{"name":"Osaka Medical and Pharmaceutical University, Osaka Prefecture, Japan","place":["Takatsuki"],"department":["Endoscopy Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6062-5697","authenticated-orcid":false,"given":"Yuichi","family":"Hirata","sequence":"additional","affiliation":[{"name":"Kakogawa Central City Hospital, Japan","place":["Kakogawa"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5794-1512","authenticated-orcid":false,"given":"Koh","family":"Kitagawa","sequence":"additional","affiliation":[{"name":"Nara Medical University, Japan","place":["Kashihara"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiko","family":"Yamada","sequence":"additional","affiliation":[{"name":"Mie University Hospital, Mie, Japan","place":["Tsu"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsaku","family":"Nagamatsu","sequence":"additional","affiliation":[{"name":"Nara Prefecture General Medical Center, Japan","place":["Nara"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetaka","family":"Tsumura","sequence":"additional","affiliation":[{"name":"Hyogo Cancer Center, Hyogo, Japan","place":["Akashi"],"department":["Department of Gastroenterological Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8728-8101","authenticated-orcid":false,"given":"Hirotsugu","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine School of Medicine, Osaka Prefecture, Japan","place":["Osaka"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3039-2303","authenticated-orcid":false,"given":"Koichiro","family":"Mandai","sequence":"additional","affiliation":[{"name":"Kyoto Second Red Cross Hospital, Japan","place":["Kyoto"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Iemoto","sequence":"additional","affiliation":[{"name":"Kitaharima Medical Center, Hyogo Prefecture, Japan","place":["Ono"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8624-7949","authenticated-orcid":false,"given":"Kotaro","family":"Takeshita","sequence":"additional","affiliation":[{"name":"Tane General Hospital, Japan","place":["Osaka"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2239-6726","authenticated-orcid":false,"given":"Satoshi","family":"Sugimori","sequence":"additional","affiliation":[{"name":"Osaka City General Hospital, Osaka Prefecture, Japan","place":["Osaka"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Itonaga","sequence":"additional","affiliation":[{"name":"Wakayama Medical University, Japan","place":["wakayama"],"department":["Second Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaaki","family":"Shimatani","sequence":"additional","affiliation":[{"name":"Kansai Medical University Medical Center, Japan","place":["Moriguchi"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Shiomi","sequence":"additional","affiliation":[{"name":"Hyogo Medical University Hospital, Hyogo, Japan","place":["Nishinomiya"],"department":["Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Miyake","sequence":"additional","affiliation":[{"name":"Kyoto Prefectural University of Medicine Graduate School of Medical Science, Japan","place":["Kyoto"],"department":["Molecular Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Fujigaki","sequence":"additional","affiliation":[{"name":"Hyogo Prefectural Harima Himeji General Medical Center, Japan","place":["Himeji"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5837-6575","authenticated-orcid":false,"given":"Osamu","family":"Inatomi","sequence":"additional","affiliation":[{"name":"Shiga University of Medical Science, Japan","place":["Otsu"],"department":["Gastroenterology, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Asada","sequence":"additional","affiliation":[{"name":"Japanese Red Cross Society Osaka Hospital, Osaka, Japan","place":["Osaka"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoya","family":"Emori","sequence":"additional","affiliation":[{"name":"Wakayama Rosai Hospital, Wakayama Prefecture, Japan","place":["Wakayama"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzo","family":"Kodama","sequence":"additional","affiliation":[{"name":"Kobe University Graduate School of Medicine, Japan","place":["Kobe"],"department":["Division of Gastroenterology, Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2964-4838.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T22:30:26Z","timestamp":1790548226000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2964-4838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,27]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1055\/a-2964-4838","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":[[2026,9,27]]},"published":{"date-parts":[[2026,9,27]]}}}