{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:01:48Z","timestamp":1791216108448,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>The present prospective multicenter clinical trial compared the efficacy and safety of balloon enteroscopy\u2010assisted endoscopic retrograde cholangiopancreatography (BEA\u2010ERCP) and endoscopic ultrasound\u2010guided biliary drainage (EUS\u2010BD) as primary drainage methods for patients with surgically altered anatomy (SAA) and unresectable malignant biliary obstruction (MBO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Technical and clinical success rates, procedure time, adverse events (AEs), and time to recurrent biliary obstruction (TRBO) were compared. Risk factors associated with technical failure were evaluated, and subgroup analysis investigating whether Roux\u2010en\u2010Y reconstruction affected the technical success rate was also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patient characteristics were comparable between the BEA\u2010ERCP (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200954) and EUS\u2010BD (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200944) groups. Compared with the BEA\u2010ERCP group, the EUS\u2010BD group had a significantly higher technical success rate, a significantly shorter procedure time, comparable rates of clinical success and AEs, and comparable TRBO. Multivariate analysis showed that BEA\u2010ERCP was an independent predictor of technical failure. Subgroup analysis revealed that the technical success rate was significantly higher with EUS\u2010BD than with BEA\u2010ERCP in patients with Roux\u2010en\u2010Y reconstruction, with no significant difference in those without Roux\u2010en\u2010Y reconstruction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EUS\u2010BD may be a more suitable primary drainage method than BEA\u2010ERCP for patients with SAA and unresectable MBO, especially those with Roux\u2010en\u2010Y reconstruction (University Hospital Medical Information Network 000049224).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>UMIN000049224<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70010","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T03:38:36Z","timestamp":1754537916000},"page":"1179-1189","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Balloon Enteroscopy\u2010Assisted\n                    <scp>ERCP<\/scp>\n                    Versus Endoscopic Ultrasound\u2010Guided Biliary Drainage for Unresectable Malignant Biliary Obstruction in Patients With Surgically Altered Anatomy: A Multicenter Prospective Registration Study"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0343-7246","authenticated-orcid":false,"given":"Masahiro","family":"Itonaga","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine Wakayama Medical University  Wakayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7308-4311","authenticated-orcid":false,"given":"Mamoru","family":"Takenaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7517-8960","authenticated-orcid":false,"given":"Kenji","family":"Ikezawa","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Oncology Osaka International Cancer Institute  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsukasa","family":"Ikeura","sequence":"additional","affiliation":[{"name":"Third Department of Internal Medicine, Division of Gastroenterology and Hepatology Kansai Medical University  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6911-7686","authenticated-orcid":false,"given":"Masaaki","family":"Shimatani","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Kansai Medical University Medical Center  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Asada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Japanese Red Cross Osaka Hospital  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4286-8804","authenticated-orcid":false,"given":"Nao","family":"Fujimori","sequence":"additional","affiliation":[{"name":"Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4961-3521","authenticated-orcid":false,"given":"Ryota","family":"Sagami","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine Oita University  Oita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2916-6568","authenticated-orcid":false,"given":"Takeshi","family":"Ogura","sequence":"additional","affiliation":[{"name":"Endoscopy Center Osaka Medical and Pharmaceutical University Hospital  Takatsuki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Imai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Okanami General Hospital  Iga Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5102-7452","authenticated-orcid":false,"given":"Kazuyuki","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Okayama University Hospital  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Shintani","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7461-8538","authenticated-orcid":false,"given":"Hideyuki","family":"Shiomi","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology Hyogo Medical University  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Hatamaru","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine Wakayama Medical University  Wakayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5407-7925","authenticated-orcid":false,"given":"Kosuke","family":"Minaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoji","family":"Takada","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Oncology Osaka International Cancer Institute  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Wan","sequence":"additional","affiliation":[{"name":"Clinical Research Center Wakayama Medical University  Wakayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshio","family":"Shimokawa","sequence":"additional","affiliation":[{"name":"Clinical Research Center Wakayama Medical University  Wakayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6885-9223","authenticated-orcid":false,"given":"Masayuki","family":"Kitano","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine Wakayama Medical University  Wakayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1291633"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.5946\/ce.2023.294"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1215108"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2021.09.008"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.420"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13414"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2001-17324"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756284820930964"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-110790"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-11329-1"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2024.03.027"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-024-02584-2"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.1187"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756283X16671671"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.10.027"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.4253\/wjge.v7.i3.283"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1365698"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-07893-x"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13878"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2022.2111228"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13927"},{"key":"e_1_2_11_23_1","first-page":"13","article-title":"Endoscopic Biliary Drainage in Surgically Altered Anatomy","volume":"13","author":"Spadaccini M.","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15019"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1222-3191"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2015.10.033"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2023.06.055"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.14428"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1392314"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-10731-z"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13300"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2011.04.046"}],"container-title":["Digestive Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/den.70010","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/den.70010","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/den.70010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:20:24Z","timestamp":1772968824000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/den.70010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":31,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/den.70010"],"URL":"https:\/\/doi.org\/10.1111\/den.70010","archive":["Portico"],"relation":{},"ISSN":["0915-5635","1443-1661"],"issn-type":[{"value":"0915-5635","type":"print"},{"value":"1443-1661","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,6]]},"assertion":[{"value":"2025-04-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}