{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:53:40Z","timestamp":1785434020237,"version":"3.56.0"},"reference-count":25,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2025-23523490"],"award-info":[{"award-number":["RS-2025-23523490"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"award":["RS-2025-23523490"],"award-info":[{"award-number":["RS-2025-23523490"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Gangnam Severance Hospital, Yonsei University College of Medicine","award":["D-2025-0014"],"award-info":[{"award-number":["D-2025-0014"]}]},{"award":["D-2025-0014"],"award-info":[{"award-number":["D-2025-0014"]}],"id":[{"id":"https:\/\/ror.org\/01wjejq96","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["RS-2024-00334498"],"award-info":[{"award-number":["RS-2024-00334498"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"award":["RS-2024-00334498"],"award-info":[{"award-number":["RS-2024-00334498"]}],"id":[{"id":"https:\/\/ror.org\/00fdzyk40","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: A fully covered self-expandable metal stent (FCSEMS) with a central waist and long retrieval string has recently been introduced for benign biliary strictures; however, its role in malignant biliary obstruction (MBO) remains unclear. This prospective, multicenter study evaluated the feasibility of palliation for unresectable distal MBO. Methods: Between April 2022 and March 2023, patients with extrahepatic MBO were enrolled across six tertiary referral centers. The FCSEMS was a silicone-covered, cross-wired nitinol stent with an anti-migration central waist 2 mm narrower than both ends, three radiopaque markers, and a 10 cm retrieval string. Stent-related outcomes and adverse events were analyzed. Results: Both technical and clinical success rates were 100% (46\/46). The median stent patency and survival times were 251 and 360 days, respectively. Stent dysfunction occurred in 18 patients (39.1%), including 10 with migration and 8 with occlusion. Stent migration was observed exclusively in the transpapillary stenting group and showed no significant association with stricture length, stent-bending angle, or the ratio of stent lengths above and below the maximal bending point. All the occluded stents were successfully removed. Early non-recurrent biliary obstruction (RBO) adverse events occurred in five patients (three with pancreatitis, one with bleeding, one with cholecystitis), whereas late non-RBO events were reported in three patients (two with cholecystitis, one with cholangitis). Conclusions: An FCSEMS with a central waist and retrieval string is feasible for the palliation of unresectable distal MBO. Optimization of the mechanical properties is warranted to minimize migration.<\/jats:p>","DOI":"10.3390\/jcm15145612","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T09:00:52Z","timestamp":1784278852000},"page":"5612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of a Fully Covered Self-Expandable Metal Stent with a Central Waist and a Long Removal String for Management of Malignant Distal Biliary Obstruction: A Multicenter Prospective Pilot Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5039-8182","authenticated-orcid":false,"given":"Min Jae","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Wook","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6642-6635","authenticated-orcid":false,"given":"Dong Kee","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang Bum","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu 1035, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6178-8338","authenticated-orcid":false,"given":"Seok","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4937-6167","authenticated-orcid":false,"given":"Sung Ill","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"76","DOI":"10.5946\/ce.2011.44.2.76","article-title":"Endoscopic stent placement in the palliation of malignant biliary obstruction","volume":"44","author":"Kim","year":"2011","journal-title":"Clin. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1111\/jgh.14955","article-title":"International consensus statements for endoscopic management of distal biliary stricture","volume":"35","author":"Nakai","year":"2019","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1038\/ajg.2016.512","article-title":"Plastic vs. Self-Expandable Metal Stents for Palliation in Malignant Biliary Obstruction: A Series of Meta-Analyses","volume":"112","author":"Almadi","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.1016\/j.gie.2011.03.1249","article-title":"Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction","volume":"74","author":"Saleem","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.cgh.2012.10.019","article-title":"No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: A meta-analysis","volume":"11","author":"Almadi","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Li, J., Li, T., Sun, P., Yu, Q., Wang, K., Chang, W., Song, Z., and Zheng, Q. (2016). Covered versus Uncovered Self-Expandable Metal Stents for Managing Malignant Distal Biliary Obstruction: A Meta-Analysis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0149066"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1111\/den.14260","article-title":"Covered versus uncovered metal stent for endoscopic drainage of a malignant distal biliary obstruction: Meta-analysis","volume":"34","author":"Yamashita","year":"2022","journal-title":"Dig. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1038\/ajg.2013.305","article-title":"Covered self-expandable metal stents with an anti-migration system improve patency duration without increased complications compared with uncovered stents for distal biliary obstruction caused by pancreatic carcinoma: A randomized multicenter trial","volume":"108","author":"Kitano","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.gie.2018.03.029","article-title":"Covered versus uncovered self-expandable metal stent for palliation of primary malignant extrahepatic biliary strictures: A randomized multicenter study","volume":"88","author":"Conio","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.gie.2023.11.035","article-title":"The optimal stent for unresectable distal malignant biliary obstruction: Is the exit from the maze of stent selection still not in sight?","volume":"99","author":"Irisawa","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4109","DOI":"10.1007\/s00464-019-06714-0","article-title":"Impact of infected stent removal on recurrent cholangitis with time-to-event analysis","volume":"33","author":"Jirapinyo","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1177\/1756283X13503614","article-title":"A randomized trial of a fully covered self-expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation","volume":"7","author":"Kaffes","year":"2014","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1111\/den.13871","article-title":"Short fully covered self-expandable metal stent for treatment of proximal anastomotic benign biliary stricture after living-donor liver transplantation","volume":"33","author":"Jang","year":"2021","journal-title":"Dig. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lee, S.-Y., Jang, S.-I., Chung, M.-J., Cho, J.-H., Do, M.-Y., Lee, H.-S., Yang, J., and Lee, D.-K. (2024). A Short Fully Covered Self-Expandable Metal Stent for Management of Benign Biliary Stricture Not Caused by Living-Donor Liver Transplantation. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051186"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A lexicon for endoscopic adverse events: Report of an ASGE workshop","volume":"71","author":"Cotton","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/jhbp.515","article-title":"Tokyo Guidelines 2018, Diagnostic criteria and severity grading of acute cholecystitis (with videos)","volume":"25","author":"Yokoe","year":"2018","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/jhbp.512","article-title":"Tokyo Guidelines 2018, Diagnostic criteria and severity grading of acute cholangitis (with videos)","volume":"25","author":"Kiriyama","year":"2018","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/den.12379","article-title":"TOKYO criteria 11 2014 for transpapillary biliary stenting","volume":"27","author":"Isayama","year":"2015","journal-title":"Dig. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.gie.2024.03.024","article-title":"Impact of the suprapapillary method on patency in distal malignant biliary obstruction: A multicenter randomized controlled trial","volume":"100","author":"Ko","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.gie.2023.10.023","article-title":"Fully covered versus partially covered self-expandable metal stents for palliation of distal malignant biliary obstruction: A systematic review and meta-analysis","volume":"99","author":"Vanella","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"633","DOI":"10.5946\/ce.2022.201","article-title":"Evaluation of the mechanical properties of current biliary self-expandable metallic stents: Axial and radial force, and axial force zero border","volume":"56","author":"Yamagata","year":"2023","journal-title":"Clin. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.gie.2008.09.032","article-title":"Measurement of radial and axial forces of biliary self-expandable metallic stents","volume":"70","author":"Isayama","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"108","DOI":"10.5946\/ce.2016.029","article-title":"Basic Knowledge about metal stent developent","volume":"49","author":"Jeong","year":"2016","journal-title":"Clin. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"goad048","DOI":"10.1093\/gastro\/goad048","article-title":"Efficacy and complications of inoperable malignant distal biliary obstruction treatment by metallic stents: Fully covered or uncovered?","volume":"11","author":"Gu","year":"2023","journal-title":"Gastroenterol. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.gie.2017.08.024","article-title":"Association of covered metallic stents with cholecystitis and stent migration in malignant biliary stricture","volume":"87","author":"Jang","year":"2018","journal-title":"Gastrointest. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T09:37:43Z","timestamp":1784281063000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":25,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145612"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145612","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]}}}