{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T03:13:42Z","timestamp":1791083622278,"version":"4.1.0"},"reference-count":123,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:00:00Z","timestamp":1592265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Japanese Foundation for Research and Promotion of Endoscopy"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>\n                    Endoscopic retrograde cholangiopancreatography with stent placement has been utilized as standard palliative management of distal malignant biliary obstruction (MBO). Compared to plastic stents, metal stents can provide longer\u2010term relief of symptoms. When a large\u2010bore metal stent is placed across the ampulla, patients are predisposed to the risk of cholangitis or stent dysfunction due to reflux of duodenal contents. To mitigate the risk of adverse events associated with the duodenobiliary reflux, efforts have been directed to development of antireflux metal stents (ARMSs). The antireflux property has been introduced through adding of an antireflux valve to the duodenal stent end. Evidence from clinical studies indicates that ARMSs may not only reduce the risk of ascending cholangitis during follow\u2010up but also prolong stent patency time. However, the results of clinical studies testing ARMSs are inconsistent owing to heterogeneous designs of antireflux valves and stent bodies. Metal stents are increasingly indicated for benign biliary strictures and MBO in the setting of neoadjuvant chemotherapy, and therefore, research is warranted to evaluate ARMSs for those indications. Given that endoscopic ultrasound (EUS)\u2010guided transmural biliary drainage has gained popularity, the optimal timing of placing an ARMS in relation to EUS\u2010guided and percutaneous drainage should be investigated. Development and evaluation of ARMSs require an integrative approach utilizing phantom and animal models, measurements of stent mechanical properties, and\n                    <jats:italic>in vivo<\/jats:italic>\n                    functional study after stent placement. In this review article, we summarize updated evidence on ARMSs for MBO and discuss issues that should be addressed in future studies.\n                  <\/jats:p>","DOI":"10.1111\/den.13679","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T10:46:05Z","timestamp":1586169965000},"page":"310-320","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Antireflux metal stent for biliary obstruction: Any benefits?"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3937-2755","authenticated-orcid":false,"given":"Tsuyoshi","family":"Hamada","sequence":"first","affiliation":[{"name":"Departments of Department of Gastroenterology Graduate School of Medicine The University of Tokyo Tokyo 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