{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:41:28Z","timestamp":1790116888259,"version":"4.0.1"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Endoscopic self-expandable metal stent (SEMS) placement is the key endoscopic treatment for unresectable malignant biliary obstruction. The benefit of covered SEMS over uncovered SEMS remains unknown as are risk factors for SEMS dysfunction. This study aimed to determine the factors associated with patency of SEMS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients with unresectable malignant biliary obstruction who underwent endoscopic SEMS placement at Ramathibodi Hospital, during January 2012 to March 2021 were included. Patient characteristics, clinical outcomes and patency of SEMS were collected. The primary outcome were stent patency and factors associated with patency of SEMS. The factors were analyzed by univariate and multivariate analyses. Median days of stent patency, median time of patient survival, rate of reintervention and complications after SEMS placement were collected.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>One hundred and fourteen patients were included. SEMS dysfunction was found in 37 patients (32.5%). Size of cancer (Hazard ratio (HR), 1.20, (95% CI 1.02, 1.40), <jats:italic>p<\/jats:italic> 0.025), presence of stones or sludge during SEMS placement (Hazard ratio (HR), 3.91, (95% CI 1.74, 8.75), <jats:italic>p<\/jats:italic> 0.001), length of SEMS, 8\u00a0cm (HR 2.96, (95% CI 1.06, 8.3), <jats:italic>p<\/jats:italic> 0.039), and total bilirubin level above 2\u00a0mg\/dL at one month after SEMS placement (HR 1.14, (95% CI 1.06, 1.22), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) were associated with SEMS dysfunction. The median stent patency was 97 days. The median patient survival was 133 days, (95% CI 75\u2013165). The rate of reintervention was 86% in patients with SEMS dysfunction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The size of cancer, presence of stones or sludge during SEMS placement, the length of SEMS, and total bilirubin level above 2\u00a0mg\/dL at 1 month after SEMS placement were associated with SEMS dysfunction. The median time of stent patency were not statistically different in each type of stent, covered stent, partially covered stent and uncovered stent. Median survival time of patients did not associate with SEMS patency or dysfunction.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-023-03028-3","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T10:03:02Z","timestamp":1699956182000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Factors associated with patency of self-expandable metal stents in malignant\u00a0biliary obstruction"],"prefix":"10.1186","volume":"23","author":[{"given":"Nottawan","family":"Suksai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patarapong","family":"Kamalaporn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supphamat","family":"Chirnaksorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukanya","family":"Siriyotha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"key":"3028_CR1","doi-asserted-by":"crossref","unstructured":"Boulay BR, Birg A. Malignant biliary obstruction: from palliation to treatment. World J Gastrointest Oncol. 2016;8(6):498\u2013508.","DOI":"10.4251\/wjgo.v8.i6.498"},{"key":"3028_CR2","first-page":"910","volume":"50","author":"JM Dumonceau","year":"2018","unstructured":"Dumonceau JM, Tringali A, Papanikolaou LS, Blero D, Mangiavillano B, Schmidt A, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European society of gastrointestinal endoscopy (ESGE) clinical guideline \u2013 updated October 2017. Eur Soc Gastrointest Endoscopy. 2018;50:910\u201330.","journal-title":"Eur Soc Gastrointest Endoscopy"},{"key":"3028_CR3","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1001\/jamaoncol.2015.3670","volume":"2","author":"S Inamdar","year":"2016","unstructured":"Inamdar S, Slattery E, Bhalla R, Sejpal DV, Trindade AJ. Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort. JAMA Oncol. 2016;2:112\u20137.","journal-title":"JAMA Oncol"},{"key":"3028_CR4","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.mjafi.2016.08.014","volume":"73","author":"H Moole","year":"2017","unstructured":"Moole H, Jaeger A, Cashman M, Volmar FH, Dhillon S, Bechtold ML, et al. Are self-expandable metal stents superior to plastic stents in palliating malignant distal biliary strictures? A meta-analysis and systematic review. Med J Armed Forces India. 2017;73:42\u20138.","journal-title":"Med J Armed Forces India"},{"key":"3028_CR5","doi-asserted-by":"publisher","first-page":"13374","DOI":"10.3748\/wjg.v21.i47.13374","volume":"21","author":"L Zorr\u00f3n Pu","year":"2015","unstructured":"Zorr\u00f3n Pu L, de Moura EG, Bernardo WM, Baracat FI, Mendon\u00e7a EQ, Kondo A, et al. Endoscopic stenting for inoperable malignant biliary obstruction: a systematic review and meta-analysis. World J Gastroenterol. 2015;21:13374\u201385.","journal-title":"World J Gastroenterol"},{"key":"3028_CR6","doi-asserted-by":"publisher","first-page":"493","DOI":"10.4240\/wjgs.v13.i5.493","volume":"13","author":"MVCV Scatimburgo","year":"2021","unstructured":"Scatimburgo MVCV, Ribeiro IB, de Moura DTH, Sagae VMT, Hirsch BS, Boghossian MB, et al. Biliary drainage in inoperable malignant biliary distal obstruction: a systematic review and meta-analysis. World J Gastrointest Surg. 2021;13:493\u2013506.","journal-title":"World J Gastrointest Surg"},{"key":"3028_CR7","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.clinre.2012.12.002","volume":"37","author":"WD Hong","year":"2013","unstructured":"Hong WD, Chen XW, Wu WZ, Zhu QH, Chen XR, et al. Metal versus plastic stents for malignant biliary obstruction: an update meta-analysis. 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Patients and hospital numbers were not collected in the datasets. \u00a0Informed consent was obtained from all subjects and\/or their legal guardians. The procedures were\u00a0performed in accordance with relevant guidelines and regulations. The study was approved by the ethics committee, Ramathibodi Hospital, Mahidol University.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"392"}}