{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T11:47:37Z","timestamp":1778672857807,"version":"3.51.4"},"reference-count":15,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"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"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The placement of plastic stents (PS), including intraductal PS (IS), is useful in patients with unresectable malignant hilar biliary obstruction (UMHBO) because of patency and ease of endoscopic reintervention (ERI). However, the optimal stent replacement method for PS remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included 322 patients with UMHBO. Among them, 146 received PS placement as initial drainage (across\u2010the\u2010papilla PS [aPS], 54; IS, 92), whereas 75 required ERI. Eight bilateral aPS, 21 bilateral IS, and 17 bilateral self\u2010expandable metallic stent (SEMS) placements met the inclusion criteria. Rates of technical and clinical success, adverse events, recurrent biliary obstruction (RBO), time to RBO (TRBO), overall survival, and secondary ERI were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no significant intergroup differences in rates of technical or clinical success, adverse events, RBO occurrence, or\u00a0overall survival. The median TRBO was significantly shorter in the\u00a0aPS group (47\u2009days) than IS (91\u2009days; <jats:italic>P<\/jats:italic>\u2009=\u20090.0196) and SEMS (143\u2009days; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) groups. Median TRBO did not differ significantly between the IS and SEMS groups (<jats:italic>P<\/jats:italic>\u2009=\u20090.44). On Cox multivariate analysis, the aPS group had the shortest stent patency (hazard ratio 2.67 [95% confidence interval 1.05\u20136.76], <jats:italic>P<\/jats:italic>\u2009=\u20090.038). For secondary ERI, the median endoscopic procedure time was significantly shorter in the IS (22\u2009min) vs. SEMS (40\u2009min) group (<jats:italic>P<\/jats:italic>\u2009=\u20090.034).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Bilateral IS and SEMS placement featured prolonged patency after first ERI. Because bilateral IS placement is faster than SEMS placement and IS can be removed during secondary ERI, it may be a good option for first ERI.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.14776","type":"journal-article","created":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T06:12:01Z","timestamp":1710569521000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluating optimal bilateral biliary stenting in endoscopic reintervention after initial plastic stent dysfunction for unresectable malignant hilar biliary obstruction: Retrospective cross\u2010sectional study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8989-6437","authenticated-orcid":false,"given":"Mitsuru","family":"Okuno","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Gifu Municipal Hospital  Gifu 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