{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T03:42:00Z","timestamp":1780976520785,"version":"3.54.1"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,3,20]],"date-time":"2013-03-20T00:00:00Z","timestamp":1363737600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Endoscopic bilateral self\u2010expandable metallic stent (<jats:styled-content style=\"fixed-case\">SEMS<\/jats:styled-content>) placement in a stent\u2010in\u2010stent method for malignant hilar biliary obstruction is technically challenging. Technical difficulties in the initial placement and reinterventions for stent occlusion are disadvantages inherent to this stent\u2010in\u2010stent method. We previously reported the feasibility of <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>iti\u2010<jats:styled-content style=\"fixed-case\">S<\/jats:styled-content> large cell <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>\u2010type biliary stents (<jats:styled-content style=\"fixed-case\">LCD<\/jats:styled-content>). This multicenter prospective consecutive study evaluated the efficacy of bilateral <jats:styled-content style=\"fixed-case\">SEMS<\/jats:styled-content> placement using modified <jats:styled-content style=\"fixed-case\">LCD<\/jats:styled-content> with large and uniform cells, a slimmer delivery system and high radial force.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>From <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>uly 2010 to <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>une 2011, 26 consecutive patients with unresectable malignant hilar biliary obstruction underwent endoscopic bilateral placement of modified <jats:styled-content style=\"fixed-case\">LCD<\/jats:styled-content> in a stent\u2010in\u2010stent method at three tertiary hospitals. Ten patients had gallbladder cancer, eight had cholangiocarcinoma, four had lymph node metastasis, two had intrahepatic cholangiocarcinoma, and two had liver metastasis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Single\u2010session and final technical success rate was 96% and 100%, respectively. Functional success rate was 89%. Stent occlusion occurred in 11 patients (42%) because of sludge (<jats:italic>n<\/jats:italic>\u2009=\u20097) or tumor ingrowth (<jats:italic>n<\/jats:italic>\u2009=\u20094). Endoscopic bilateral reintervention was technically easy and successful: six patients had stent clearance by balloon sweeping and five had plastic stent placement. According to <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>aplan\u2013<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>eier analysis, median survival and stent patency were 220 days and 157 days, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Modified <jats:styled-content style=\"fixed-case\">LCD<\/jats:styled-content> achieved a high technical success rate both in the initial stent\u2010in\u2010stent placement and in bilateral reinterventions in patients with malignant hilar biliary obstruction.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.12055","type":"journal-article","created":{"date-parts":[[2013,3,20]],"date-time":"2013-03-20T13:12:45Z","timestamp":1363785165000},"page":"93-99","source":"Crossref","is-referenced-by-count":58,"title":["High single\u2010session success rate of endoscopic bilateral stent\u2010in\u2010stent placement with modified large cell <scp>N<\/scp>iti\u2010<scp>S<\/scp> stents for malignant hilar biliary obstruction"],"prefix":"10.1111","volume":"26","author":[{"given":"Hirofumi","family":"Kogure","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Isayama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousuke","family":"Nakai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Tsujino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Graduate School of Medicine The University of Tokyo  Tokyo 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