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Original Article
- Efficacy of multi-hole self‑expandable metallic stents versus partially covered self‑expandable metallic stents in patients with malignant distal biliary obstruction caused by unresectable pancreatic cancer: a retrospective comparative cohort study in Japan
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Shohei Asada
, Koh Kitagawa, Fumimasa Tomooka, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Hitoshi Yoshiji - Clin Endosc 2025;58(5):744-756. Published online August 26, 2025
- DOI: https://doi.org/10.5946/ce.2024.340
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Graphical Abstract
Abstract
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ePub - Background
/Aims: This study aimed to compare the stent patency between the novel multi-hole self-expandable metallic stent (MH-SEMS) and conventional partially covered SEMS (PC-SEMS) for malignant distal biliary obstruction (MDBO) in patients with pancreatic carcinoma.
Methods
This retrospective study compared stent patency between patients with MH-SEMS (n=43) and those with PC-SEMS (n=94). Secondary outcomes were overall survival (OS), incidence of recurrent biliary obstruction (RBO), causes of RBO, and adverse events (AEs).
Results
The median time to RBO did not differ significantly between the MH-SEMS and PC-SEMS groups (318 vs. 460 days, p=0.17). Furthermore, the two groups did not differ significantly in terms of OS and incidence rate of AEs, including RBO and cholecystitis. RBO caused by tumor ingrowth was slightly more common in the MH-SEMS group (p=0.089). The MH-SEMS group had a slightly lower 12-month non-obstruction rate than the PC-SEMS group (33.9% vs. 60.9%). In the MH-SEMS group, stent removal was successful in all seven patients in whom it was attempted.
Conclusions
The clinical outcomes of MH-SEMS and PC-SEMS were similar in patients with MDBO caused by pancreatic carcinoma were similar. -
Citations
Citations to this article as recorded by
- Multi-Hole Self-Expandable Metallic Stent for Malignant Distal Biliary Obstruction: A Literature Review
Koh Kitagawa, Shohei Asada, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Akira Mitoro, Hitoshi Yoshiji
Journal of Clinical Medicine.2026; 15(4): 1410. CrossRef - Efficacy of fully covered self-expanding metal stents removal versus stent-in-stent techniques in recurrent malignant distal biliary obstruction
See Young Lee, Sung Ill Jang, Eui Joo Kim, Dong Ki Lee, Seoyeon Cho, Yeseul Seong, Jung Hyun Jo, Chan Min Jung, In Rae Cho, Woo Hyun Paik, Ji Kon Ryu, Hyun Seok Lee, Sang Hyub Lee, Jae Hee Cho
Scientific Reports.2026;[Epub] CrossRef - Advancements in stent strategies for malignant distal biliary obstruction: defining the clinical role of multi-hole self-expandable metal stents
Sung Yong Han
Clinical Endoscopy.2025; 58(5): 698. CrossRef - Endoscopic biliary drainage with multi-hole self-expandable metallic stent during neoadjuvant chemoradiotherapy in pancreatic cancer
Shohei Asada, Koh Kitagawa, Junichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Minako Nagai, Hitoshi Yoshiji, Masayuki Sho
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
- Multi-Hole Self-Expandable Metallic Stent for Malignant Distal Biliary Obstruction: A Literature Review
- 3,247 View
- 102 Download
- 3 Web of Science
- 4 Crossref
Brief Report
- Black esophagus: a life-threatening adverse event associated with endoscopic retrograde cholangiopancreatography
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Koh Kitagawa, Hiroyuki Masuda, Akira Mitoro, Fumimasa Tomooka, Shohei Asada, Norihisa Nishimura, Kosuke Kaji, Hitoshi Yoshiji
- Clin Endosc 2024;57(2):270-273. Published online May 23, 2023
- DOI: https://doi.org/10.5946/ce.2023.047
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PDFPubReaderePub
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Citations
Citations to this article as recorded by- Acute oesophageal necrosis: single centre experience
Şehmus Ölmez, Duran Deha Çetin, Mustafa Harı, Abdullah İlhan, Bünyamin Sarıtaş
BMC Gastroenterology.2026;[Epub] CrossRef - The two-hit hypothesis in acute esophageal necrosis: black esophagus in severe atherosclerosis and untreated gastroesophageal reflux disease: a case report
Sushrut Ingawale, Pujitha Vallivedu, Anchit Chauhan, Jack Jacob, Asim Haider, Prabin Sharma
Journal of Medical Case Reports.2026;[Epub] CrossRef - A Case of Black Esophagus in a Patient Presenting With Dyspnea
Jaehong Jeong, June Hwa Bae, Hyeong Ho Jo, Joong Goo Kwon, Eun Young Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(3): 284. CrossRef - Relato de caso: Esôfago negro
Victor Vasconcellos Pardo, Lara Fernandes Polzatto, Vivian Motta Guimarães
Research, Society and Development.2025; 14(9): e5214949535. CrossRef
- Acute oesophageal necrosis: single centre experience
- 6,223 View
- 259 Download
- 1 Web of Science
- 4 Crossref
Original Articles
- Laser-cut-type versus braided-type covered self-expandable metallic stents for distal biliary obstruction caused by pancreatic carcinoma: a retrospective comparative cohort study
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Koh Kitagawa, Akira Mitoro, Takahiro Ozutsumi, Masanori Furukawa, Yukihisa Fujinaga, Kenichiro Seki, Norihisa Nishimura, Yasuhiko Sawada, Kosuke Kaji, Hideto Kawaratani, Hiroaki Takaya, Kei Moriya, Tadashi Namisaki, Takemi Akahane, Hitoshi Yoshiji
- Clin Endosc 2022;55(3):434-442. Published online October 28, 2021
- DOI: https://doi.org/10.5946/ce.2021.161
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Abstract
PDFPubReaderePub
- Background
/Aims: Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs.
Methods
To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems.
Results
In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braidedtype CMSs. There were no differences in the survival duration between the groups.
Conclusions
The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cuttype. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs. -
Citations
Citations to this article as recorded by- Comparison of the Usefulness of Covered and Uncovered Laser‐cut Metal Stents
Toshio Fujisawa, Masao Toki, Kei Saito, Yuta Hasegawa, Eisuke Iwasaki, Michihiro Saito, Katsuya Kitamura, Ryosuke Tonozuka, Takao Itoi, Ken Ito, Keiko Kaneko, Naminatsu Takahara, Tadakazu Hisamatsu, Hiroyuki Isayama
DEN Open.2026;[Epub] CrossRef - Multi-Hole Self-Expandable Metallic Stent for Malignant Distal Biliary Obstruction: A Literature Review
Koh Kitagawa, Shohei Asada, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Akira Mitoro, Hitoshi Yoshiji
Journal of Clinical Medicine.2026; 15(4): 1410. CrossRef - Prevention of stent migration of covered self-expandable metal stents in distal malignant biliary obstruction: a review of literature
Jung Won Chun, Woo Hyun Paik, Sang Myung Woo, Jin Ho Choi, In Rae Cho, Woo Jin Lee, Ji Kon Ryu, Yong-Tae Kim, Sang Hyub Lee
Gastroenterology Report.2025;[Epub] CrossRef - From dogma to individualized care: the potential of 6-mm fully covered self-expandable metal stent in unresectable malignant distal biliary obstruction
Hyung Ku Chon
Clinical Endoscopy.2025; 58(4): 630. CrossRef - Duodenal Stenting Is Associated with Longer Biliary Patency in Endoscopic Ultrasound-Guided Biliary Drainage: Potential Role of Braided Biliary Stents
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Yuichi Waragai, Hiroyuki Asama, Hiroshi Shimizu, Kentaro Sato, Kento Osawa, Rei Ohira, Jun Nakamura, Mika Takasumi, Tsunetaka Kato, Takumi Yanagita, Mitsuru Otsuka, Takuto Hikichi, Hiromasa Ohira
Oncology.2025; : 1. CrossRef - Braided-type stent versus laser-cut-type stent for patients with unresectable distal malignant biliary obstruction: a randomized controlled trial
Sho Hasegawa, Takamitsu Sato, Satoru Shinoda, Yusuke Kurita, Tomoki Ogata, Shinichi Nihei, Shin Yagi, Kunihiro Hosono, Itaru Endo, Noritoshi Kobayashi, Kensuke Kubota, Atsushi Nakajima
Gastrointestinal Endoscopy.2024; 99(5): 739. CrossRef - Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study
Yuto Yamada, Takashi Sasaki, Tsuyoshi Takeda, Takeshi Okamoto, Takafumi Mie, Chinatsu Yonekura, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Takahisa Matsuda, Yoshinori Igarashi, Naoki Sasahira
DEN Open.2023;[Epub] CrossRef - Comparable Efficacy of Laser-Cut and Braided Self Expanding Metallic Biliary Stent: A Systematic Review and Meta-Analysis
Priyadarshini Loganathan, Saurabh Chandan, Babu P. Mohan, Shreyas Saligram, Douglas G. Adler
Digestive Diseases and Sciences.2023; 68(9): 3756. CrossRef - Evaluation of the mechanical properties of current biliary self-expandable metallic stents: axial and radial force, and axial force zero border
Wataru Yamagata, Toshio Fujisawa, Takashi Sasaki, Rei Ishibashi, Tomotaka Saito, Shuntaro Yoshida, Shizuka No, Kouta Inoue, Yousuke Nakai, Naoki Sasahira, Hiroyuki Isayama
Clinical Endoscopy.2023; 56(5): 633. CrossRef - Covered self-expandable metal stents for distal biliary obstruction from pancreatic carcinoma: what type of stent is preferred?
Hideyuki Shiomi, Ryota Nakano, Shogo Ota
Clinical Endoscopy.2022; 55(3): 369. CrossRef
- Comparison of the Usefulness of Covered and Uncovered Laser‐cut Metal Stents
- 6,244 View
- 304 Download
- 10 Web of Science
- 10 Crossref
- Efficacy of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumor
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Masanori Furukawa, Akira Mitoro, Takahiro Ozutumi, Yukihisa Fujinaga, Keisuke Nakanishi, Koh Kitagawa, Soichiro Saikawa, Sinya Sato, Yasuhiko Sawada, Hiroaki Takaya, Kosuke Kaji, Hideto Kawaratani, Tadashi Namisaki, Kei Moriya, Takemi Akahane, Junichi Yamao, Hitoshi Yoshiji
- Clin Endosc 2021;54(3):371-378. Published online February 18, 2021
- DOI: https://doi.org/10.5946/ce.2020.147
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Abstract
PDFPubReaderePub
- Background
/Aims: Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. We compared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospective analysis.
Methods
Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) between January 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time, and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMR group.
Results
The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en bloc resection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min, p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patients treated with piecemeal resection in the CEMR group had residual tumors.
Conclusions
UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment. -
Citations
Citations to this article as recorded by- High Rates of Defect Closure After Resection of Large Nonpedunculated Colorectal Lesions Using a Through‐The‐Scope Clip With Anchor Prongs
Daniel von Renteln, Douglas K. Rex, Heiko Pohl, Nikhil A. Kumta, Shannon Chan, Marvin Ryou, Zaheer Nabi, Ping Hong Zhou, Haruhiro Inoue, Joyce A. Peetermans, Matthew J. Rousseau, Jeffrey D. Mosko
United European Gastroenterology Journal.2026;[Epub] CrossRef - Overtube Use Reduces the Incidence of Aspiration Pneumonia Following Gastric Endoscopic Submucosal Dissection: A Large, Single‐Center Japanese Experience
Satoshi Iwai, Yukihisa Fujinaga, Hitoshi Mori, Masayoshi Takami, Jun‐ichi Hanatani, Hiroyuki Masuda, Akihiko Shibamoto, Shohei Asada, Yuki Tsuji, Shinya Sato, Norihisa Nishimura, Koh Kitagawa, Kosuke Kaji, Tadashi Namisaki, Akira Mitoro, Hitoshi Yoshiji
DEN Open.2026;[Epub] CrossRef - Underwater Endoscopic Mucosal Resection Vs Conventional Endoscopic Mucosal Resection for Superficial Nonampullary Duodenal Epithelial Tumors in the Western Setting
Rui Morais, José Amorim, Renato Medas, Bernardo Sousa-Pinto, João Santos-Antunes, Romain Legros, Jérémie Albouys, Frédéric Moll, Margarida Marques, Filipe Vilas-Boas, Eduardo Rodrigues-Pinto, Irene Gullo, Fátima Carneiro, Elisa Gravito Soares, Pedro Amaro
Clinical Gastroenterology and Hepatology.2025; 23(1): 79. CrossRef - Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
Hye Kyung Jeon, Gwang Ha Kim
Gut and Liver.2025; 19(1): 19. CrossRef - Clinical outcomes of endoscopic mucosal resection for large superficial nonampullary duodenal epithelial tumor: a single-center study
Federico Barbaro, Luigi Giovanni Papparella, Michele Francesco Chiappetta, Tommaso Schepis, Rossella Maresca, Livio Enrico Del Vecchio, Cristina Ciuffini, Silvia Pecere, Lucio Petruzziello, Guido Costamagna, Cristiano Spada
European Journal of Gastroenterology & Hepatology.2025; 37(4): 439. CrossRef - Comparison of the resection depth between endoscopic mucosal resection and underwater endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumors: A retrospective study
Toshiki Horii, Yohei Harada, Gen Kitahara, Takuya Wada, Akinori Watanabe, Kenji Ishido, Hisatomo Ikehara, Chika Kusano
DEN Open.2025;[Epub] CrossRef - Tip‐In Underwater Endoscopic Mucosal Resection for Superficial Nonampullary Duodenal Epithelial Tumors ≤ 20 mm
Tomoya Ueda, Shunsuke Yoshii, Kazuki Matsuyama, Yasuhiro Tani, Yoshiaki Ando, Gentaro Tanabe, Yuta Fujimoto, Noriaki Ito, Nobutoshi Tsukuda, Muneshin Morita, Minoru Kato, Takashi Kanesaka, Satoki Shichijo, Sachiko Yamamoto, Koji Higashino, Noriya Uedo, To
Journal of Gastroenterology and Hepatology.2025; 40(10): 2540. CrossRef - Management of Adverse Events Related to Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
Osamu Dohi, Tomoko Ochiai, Mayuko Seya, Katsuma Yamauchi, Naoto Iwai, Reo Kobayashi, Ryohei Hirose, Elsayed Ghoneem, Ken Inoue, Naohisa Yoshida
Digestion.2025; : 1. CrossRef - Current Management of Duodenal Neoplasia: Endoscopic Treatment for Large Superficial Non-Ampullary Duodenal Epithelial Tumor
Kurato Miyazaki, Naohisa Yahagi, Motohiko Kato
Digestion.2025; : 1. CrossRef - Comparison of Therapeutic Outcomes between Underwater EMR and Cap-Assisted EMR for Superficial Non-Ampullary Duodenal Epithelial Tumors Measuring 6–20 mm
Eri Nishikawa, Tetsuya Yoshizaki, Erika Abe, Hiroyuki Hashimoto, Makoto Yoshiji, Shoko Matsuura, Tomonori Wada, Yuta Higasa, Hiroshi Tanabe, Shinya Hoki, Ryosuke Ishida, Ryosuke Hori, Tatsuya Nakai, Chise Ueda, Satoshi Urakami, Hirofumi Abe, Madoka Takao,
Digestion.2025; : 1. CrossRef - Conventional versus underwater endoscopic resection for superficial non-ampullary duodenal epithelial tumours
Hajime Miyazaki, Osamu Dohi, Tsugitaka Ishida, Mayuko Seya, Katsuma Yamauchi, Hayato Fukui, Takeshi Yasuda, Takuma Yoshida, Naoto Iwai, Toshifumi Doi, Ryohei Hirose, Ken Inoue, Akihito Harusato, Naohisa Yoshida, Kazuhiko Uchiyama, Tomohisa Takagi, Takeshi
Japanese Journal of Clinical Oncology.2024; 54(2): 137. CrossRef - Can underwater endoscopic mucosal resection be an alternative to conventional endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumors?
Hidenori Tanaka, Yuji Urabe, Hiroki Takemoto, Kazuki Ishibashi, Hirona Konishi, Yuka Matsubara, Yudai Takehara, Shin Morimoto, Fumiaki Tanino, Noriko Yamamoto, Hajime Teshima, Junichi Mizuno, Issei Hirata, Hirosato Tamari, Akiyoshi Tsuboi, Ken Yamashita,
DEN Open.2024;[Epub] CrossRef - Underwater Techniques in Gastrointestinal Endoscopy: Diving into the Depths
Sandro Sferrazza, Giulio Calabrese, Roberta Maselli, Rui Morais, Antonio Facciorusso, Georgios Mavrogenis, Roberto Di Mitri, Alessandro Repici, Marcello Maida
Cancers.2024; 16(20): 3535. CrossRef - Underwater versus conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumors ≤20mm: A systematic review and meta-analysis
Xiu-He Lv, Rong Luo, Qing Lu, Kai Deng, Jin-Lin Yang
Digestive and Liver Disease.2023; 55(6): 714. CrossRef - Underwater Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors: A Systematic Review and Meta-Analysis
Jae Gon Lee, Sang Pyo Lee, Hyun Joo Jang, Sea Hyub Kae
Digestive Diseases and Sciences.2023; 68(4): 1482. CrossRef - A feasibility study comparing gel immersion endoscopic resection and underwater endoscopic mucosal resection for superficial nonampullary duodenal epithelial tumors
Akihiro Miyakawa, Toshio Kuwai, Yukie Sakuma, Manabu Kubota, Akira Nakamura, Ei Itobayashi, Haruhisa Shimura, Yoshio Suzuki, Kenji Shimura
Endoscopy.2023; 55(03): 261. CrossRef - Underwater Endoscopic Mucosal Resection Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors ≤20 mm
Zhikun Yin, Ji Li, Weilin Yang, Weifeng Huang, Dong Xu, Xiaoyi Lei, Jinyan Zhang
Journal of Clinical Gastroenterology.2023; 57(9): 928. CrossRef - Efficacy and safety of underwater endoscopic mucosal resection for ≤20 mm superficial non-ampullary duodenal epithelial tumors: Systematic review and meta-analysis
Jixiang Liu, Shaojie Duan, Yichong Wang, Hongye Peng, Youjia Kong, Shukun Yao
Frontiers in Medicine.2023;[Epub] CrossRef - Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial
Luciano Lenz, Bruno Martins, Gustavo Andrade de Paulo, Fabio Shiguehissa Kawaguti, Elisa Ryoka Baba, Ricardo Sato Uemura, Carla Cristina Gusmon, Sebastian Naschold Geiger, Renata Nobre Moura, Caterina Pennacchi, Marcelo Simas de Lima, Adriana Vaz Safatle-
Gastrointestinal Endoscopy.2023; 97(3): 549. CrossRef - Endoscopic resection of superficial non‐ampullary duodenal epithelial tumor
Motohiko Kato, Takanori Kanai, Naohisa Yahagi
DEN Open.2022;[Epub] CrossRef - The Application of Underwater Endoscopic Mucosal Resection for Nonampullary Duodenal Adenomas
Xiu-He Lv, Jin-Lin Yang
Clinical Gastroenterology and Hepatology.2022; 20(8): 1884. CrossRef - Utility of underwater EMR for nonpolypoid superficial nonampullary duodenal epithelial tumors ≤20 mm
Kenichiro Okimoto, Daisuke Maruoka, Tomoaki Matsumura, Kengo Kanayama, Naoki Akizue, Yuki Ohta, Takashi Taida, Keiko Saito, Yosuke Inaba, Yohei Kawasaki, Makoto Arai, Jun Kato, Naoya Kato
Gastrointestinal Endoscopy.2022; 95(1): 140. CrossRef - Reply
Yasushi Yamasaki, Noriya Uedo
Clinical Gastroenterology and Hepatology.2022; 20(8): 1884. CrossRef - Appropriate selection of endoscopic resection for superficial nonampullary duodenal adenomas in association with recurrence
Kenichiro Okimoto, Daisuke Maruoka, Tomoaki Matsumura, Kengo Kanayama, Naoki Akizue, Yuki Ohta, Takashi Taida, Keiko Saito, Yosuke Inaba, Yohei Kawasaki, Jun Kato, Naoya Kato
Gastrointestinal Endoscopy.2022; 95(5): 939. CrossRef - Reply to Lv and Yang
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Endoscopy.2022; 54(05): 523. CrossRef - Endoscopic treatment selection for superficial duodenal tumors: pay attention to small lesions
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Endoscopy.2022; 54(05): 522. CrossRef - Resectability of underwater endoscopic mucosal resection for duodenal tumor: A single‐center, retrospective pilot study
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Journal of Gastroenterology and Hepatology.2021; 36(11): 3191. CrossRef
- High Rates of Defect Closure After Resection of Large Nonpedunculated Colorectal Lesions Using a Through‐The‐Scope Clip With Anchor Prongs
- 7,828 View
- 189 Download
- 28 Web of Science
- 27 Crossref
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