{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:19:47Z","timestamp":1792718387649,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,12,28]],"date-time":"2019-12-28T00:00:00Z","timestamp":1577491200000},"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":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Endoscopic stenting for unresectable malignant hilar biliary strictures (MHBS) remains challenging. Post\u2010endoscopic retrograde cholangiopancreatography cholangitis (PEC) can be the most common and fatal adverse event. In the present study, we aimed to systematically evaluate the incidence, severity, risk factors, and consequences of PEC after endoscopic procedures for advanced MHBS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Of 924 patients, we identified 502 patients with MHBS (Bismuth types II to IV) who underwent endoscopic stenting as the primary therapy at two centers over 16\u00a0years. PEC and its severity were verified according to the current Tokyo guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 108 patients (21.5%) experienced acute PEC. Mild, moderate, and severe cholangitis were encountered in 51 (10.1%), 42 (8.4%), and 15 (3.0%) patients, respectively. Multivariate analyses showed that metal stenting (verse plastic stenting) (OR 0.328, 95% CI 0.200\u20130.535, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and Bismuth classification (IV <jats:italic>vs<\/jats:italic> III\/II) (OR 2.499, 95% CI 1.150\u20135.430) were independent predictors for PEC and the moderate\/severe type. Patients with PEC had significantly lower clinical success rates (86.3% <jats:italic>vs<\/jats:italic> 41.7%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), a higher rate of early death (6.5% <jats:italic>vs<\/jats:italic> 0.5%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), a shorter median stent patency (4.9 <jats:italic>vs<\/jats:italic> 6.4\u00a0months, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), and shorter overall survival (2.6 <jats:italic>vs<\/jats:italic> 5.2\u00a0months, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) compared with the noncholangitis group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>\ufeffAfter endoscopic stenting for advanced MHBS, cholangitis may occur in as many as 21.5% of patients, which may be associated with a poor prognosis. The risk is high in patients with Bismuth type IV and may be reduced by using metal stents.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.14954","type":"journal-article","created":{"date-parts":[[2019,12,5]],"date-time":"2019-12-05T05:25:47Z","timestamp":1575523547000},"page":"1150-1157","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["The risk of acute cholangitis after endoscopic stenting for malignant hilar strictures: A large comprehensive study"],"prefix":"10.1111","volume":"35","author":[{"given":"Ming\u2010Xing","family":"Xia","sequence":"first","affiliation":[{"name":"Department of Endoscopy, Eastern Hepatobiliary Hospital Second Military Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu\u2010Ping","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Eastern Hepatobiliary Hospital Second Military Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Third Affiliated Hospital Second Military Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dao\u2010Jian","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Eastern Hepatobiliary Hospital Second Military Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Eastern Hepatobiliary Hospital Second Military Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian\u2010Tian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Eastern Hepatobiliary Hospital Second Military Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Third Affiliated Hospital Second Military Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4167-9083","authenticated-orcid":false,"given":"Bing","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Eastern Hepatobiliary Hospital Second Military Medical University  Shanghai China"},{"name":"Department of Gastroenterology, Third Affiliated Hospital Second Military Medical University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mge.2002.125364"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0659-9864"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.4253\/wjge.v7.i7.675"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e328360b9ec"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.5946\/ce.2013.46.3.260"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2010.06.040"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.509"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1012830"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/20.5.1236"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(98)70121-X"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2001.03594.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1014733226337"},{"key":"e_1_2_7_14_1","first-page":"305","article-title":"Absence of intestinal bile promotes bacterial translocation","volume":"58","author":"Slocum MM","year":"1992","journal-title":"Am. 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