{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:35:13Z","timestamp":1790778913713,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,6,7]],"date-time":"2020-06-07T00:00:00Z","timestamp":1591488000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endoscopic stenting to manage malignant hilar biliary obstruction has no consensus regarding the optimal stenting strategy. In this multicenter study, we compared transpapillary parallel\u2010style bilateral metal stenting with bilateral plastic stenting, and evaluated short\u2010 and long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We recruited 262 consecutive patients (Bismuth classification types II\u2013IV) who underwent either bilateral metal or plastic stenting as primary therapy at four tertiary centers. To overcome selection bias, we performed 1:1 propensity score matching. Our primary outcome was overall survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After propensity score matching, each group comprised 96 patients, with no significant differences in any baseline characteristics. The median survival was significantly longer in the metal stenting group than in the plastic stenting group (7.2\u00a0months [95%\u00a0CI 6.0\u20138.5] vs. 4.1\u00a0months [95%\u00a0CI 2.9\u20135.3];\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.015). The clinical success rates were significantly higher in the metal stenting group than in the plastic stenting group (99.0% vs. 71.9%, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), and lower post\u2010procedure cholangitis incidence (7.3% vs. 26.0%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), longer median symptom\u2010free stent patency (9.2\u00a0months [95%\u00a0CI 7.6\u201310.6] vs. 4.8\u00a0months [95%\u00a0CI 4.2\u20135.3];\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), and fewer total interventions (1.3\u00a0\u00b1\u00a00.6 vs. 2.0\u00a0\u00b1\u00a01.4;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). In multivariate Cox analysis of the overall survival, metal stenting (HR 0.589,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.002), hilar cholangiocarcinoma (HR 0.419,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.009), and adjuvant treatment (HR 0.596,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.006) were independent predictors of death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Endoscopic therapy using bilateral metal stenting is superior to bilateral plastic stenting, with prolonged overall survival, higher clinical success, and longer stent patency in patients with advanced hilar biliary malignancies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.13680","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T03:29:13Z","timestamp":1586143753000},"page":"179-189","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Comparison of endoscopic bilateral metal stent drainage with plastic stents in the palliation of unresectable hilar biliary malignant strictures: Large multicenter study"],"prefix":"10.1111","volume":"33","author":[{"given":"Ming\u2010Xing","family":"Xia","sequence":"first","affiliation":[{"name":"Departments of Department of Endoscopy Eastern Hepatobiliary Hospital Second Military Medical University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang\u2010Lin","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Xijing Hospital Affiliated to Fourth Military Medical University Xi'an 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