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Original Articles
- Efficacy of double half-pigtail plastic stents for endoscopic biliary drainage of acute calculous cholangitis
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Toshitaka Sakai
, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Hidehito Sumiya, Jun Horaguchi, Masaya Oikawa, Takashi Tsuchiya, Yutaka Noda, Kei Ito - Clin Endosc 2025;58(6):898-908. Published online November 11, 2025
- DOI: https://doi.org/10.5946/ce.2025.134
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Graphical Abstract
Abstract
PDF - Background
/Aims: Plastic stent placement is required when biliary stones cannot be completely removed during the initial endoscopic retrograde cholangiopancreatography (ERCP). Although double half-pigtail plastic stents (DHPs) help prevent stent migration, their clinical utility has not yet been evaluated.
Methods
We retrospectively reviewed data from 221 patients who underwent DHP placement for acute calculous cholangitis (ACC) between January 2015 and March 2024. Patient without complete stone removal during initial ERCP were included. Clinical success, adverse events, recurrent biliary obstruction (RBO), and time to RBO (TRBO) were compared in 21 patients treated with straight plastic stents (STs) under similar conditions.
Results
Clinical success was achieved in 99% of patients in the DHP group and 95% of the ST group (p=0.13). Adverse event rates were comparable between groups. During follow-up, the DHP group had significantly lower stent occlusion (2% vs. 20%, p<0.01) and migration rates (4% vs. 15%, p=0.02), leading to a lower RBO rate (5% vs. 35%, p<0.01). The median TRBO was significantly longer in the DHP group (585 vs. 247 days, p<0.01).
Conclusions
DHPs had comparable efficacy to STs, with significantly fewer stent-related adverse events. This may be a potential option for biliary drainage in ACC. -
Citations
Citations to this article as recorded by
- Clinical Outcomes of Double Half‐Pigtail Versus Straight Plastic Stents for Endoscopic Biliary Drainage of Malignant Distal Biliary Obstruction
Wataru Yoshioka, Mutsumi Tasaki, Hinata Tasaki, Hikaru Fujimoto, Shuzo Yunotani, Chika Inadomi, Shotaro Noge, Yoshihito Kubotsu, Futa Koga
DEN Open.2027;[Epub] CrossRef
- Clinical Outcomes of Double Half‐Pigtail Versus Straight Plastic Stents for Endoscopic Biliary Drainage of Malignant Distal Biliary Obstruction
- 3,658 View
- 82 Download
- 1 Web of Science
- 1 Crossref
- Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study
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Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Toji Murabayashi, Fumisato Kozakai, Jun Horaguchi, Yutaka Noda, Kei Ito
- Clin Endosc 2020;53(6):735-742. Published online March 4, 2020
- DOI: https://doi.org/10.5946/ce.2020.003
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Abstract
PDF
- Background
/Aims: The aim of this study was to evaluate outcomes of inside plastic stents (iPSs) versus those of metal stents (MSs) for treating unresectable perihilar malignant obstructions.
Methods
For all patients who underwent endoscopic suprapapillary placement of iPS(s) or MS(s) as the first permanent biliary drainage for unresectable malignant perihilar obstructions between January 2014 and August 2019, clinical outcomes using iPSs (n=20) and MSs (n=85), including clinical efficacy, adverse events, and time to recurrence of biliary obstruction (RBO), were retrospectively evaluated.
Results
There were no differences in clinical effectiveness (95% for the iPS group vs. 92% for the MS group, p=1.00). Procedure-related adverse events, including pancreatitis, acute cholangitis, acute cholecystitis, and death, were observed for 8% of the MS group, although no patient in the iPS group developed such adverse events. The median time to RBO was 561 days (95% confidence interval, 0–1,186 days) for iPSs and 209 days (127–291 days) for MSs, showing a significant difference (p=0.008).
Conclusions
Time to RBO after iPS placement was significantly longer than that after MS placement. IPSs, which are removable, unlike MSs, were an acceptable option. -
Citations
Citations to this article as recorded by- Efficacy of Drainage Combining Endoscopic Retrograde Cholangiopancreatography With Endoscopic Ultrasound‐guided Biliary Drainage for Difficult‐to‐Control Cholangitis in Patients With Hilar Cholangiocarcinoma
Tomoki Ogata, Yusuke Kurita, Takamitsu Sato, Shin Yagi, Yu Honda, Takeshi Iizuka, Sho Hasegawa, Kunihiro Hosono, Noritoshi Kobayashi, Itaru Endo, Kensuke Kubota, Masato Yoneda, Atsushi Nakajima
DEN Open.2026;[Epub] CrossRef - Clinical utility of suprapapillary plastic stents for lifelong biliary drainage in unresectable malignant hilar biliary obstruction
Hisahiro Uemura, Takashi Kobayashi, Atsuhiro Masuda, Kenta Yamamoto, Kaoruko Kanamaru, Takafumi Tokunaga, Akira Shirohata, Tetsuhisa Ko, Yusuke Yokotani, Yuki Oka, Yosuke Irie, Noriko Juri, Yoshiyuki Harada, Mika Miki, Noriko Inomata, Kae Nagao, Shinya Ko
Gastrointestinal Endoscopy.2026; 103(3): 475. CrossRef - The selection and strategy of stents in endoscopic drainage of unresectable perihilar cholangiocarcinoma: a meta-analysis
Xiaoyi Guo, Jinqi Xing, Haifeng Luo, Di Zhang, Feng Gao, Zihao Dai, Jianfeng Huo, Zhuo Yang, Jiangning Gu
BMC Surgery.2026;[Epub] CrossRef - Modern endoscopic strategies for the diagnosis and management of cholangiocarcinoma
Coskun Ozer Demirtas, Anna Pelach Pueyo, Amanda H Lim, Faisal Shaukat Ali, Tyler M Berzin
Frontline Gastroenterology.2026; : flgastro-2026-103852. CrossRef - Unilateral drainage and chemotherapy prolong the patency of a plastic stent placed above the sphincter of Oddi in patients with malignant hilar biliary obstruction
Fumimasa Tomooka, Koh Kitagawa, Akira Mitoro, Yukihisa Fujinaga, Norihisa Nishimura, Tadashi Namisaki, Takemi Akahane, Kosuke Kaji, Shohei Asada, Shinya Sato, Jun‐Ichi Hanatani, Hitoshi Mori, Yuki Motokawa, Tomihiro Iwata, Hiroki Kachi, Yui Osaki, Hitoshi
DEN Open.2025;[Epub] CrossRef - Evaluating safety and efficacy of plastic versus metal stenting in malignant hilar biliary obstruction: a systematic review and meta-analysis of randomized controlled trials
Xinjie Luo, Zhicheng Huang, Kamran Ali, Khizar Hayat
Postgraduate Medical Journal.2025; 101(1195): 447. CrossRef - Development and application of an early warning model for predicting early mortality following stent placement in malignant biliary obstruction: A comparative analysis of logistic regression and artificial neural network approaches
Yongxin Ma, Jiaojiao Qi, Xusheng Zhang, Kejun Liu, Yimin Liu, Xuehai Yu, Yang Bu, Bendong Chen
Oncology Letters.2025; 29(5): 1. CrossRef - Endoscopic nasobiliary drainage versus endoscopic biliary stenting for preoperative biliary drainage in patients with malignant hilar biliary obstruction: Propensity score‐matched multicenter comparative study
Hirotoshi Ishiwatari, Takanori Kawabata, Hiroki Kawashima, Yousuke Nakai, Shin Miura, Hironari Kato, Hideyuki Shiomi, Nao Fujimori, Takeshi Ogura, Osamu Inatomi, Kensuke Kubota, Toshio Fujisawa, Mamoru Takenaka, Hiroshi Mori, Kensaku Noguchi, Yuki Fujii,
Digestive Endoscopy.2024; 36(6): 726. CrossRef - Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis
Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yuhei Iwasa, Shinya Uemura, Kensaku Yoshida, Akinori Maruta, Takuji Iwashita, Ichiro Yasuda, Masahito Shimizu
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(4): 284. CrossRef - A Novel Method of Calculating the Drained Liver Volume Using a 3D Volume Analyzer for Biliary Drainage of Unresectable Malignant Hilar Biliary Obstruction
Naoto Imagawa, Mitsuharu Fukasawa, Shinichi Takano, Satoshi Kawakami, Yoshimitsu Fukasawa, Hiroyuki Hasegawa, Natsuhiko Kuratomi, Shota Harai, Naruki Shimamura, Dai Yoshimura, Shoji Kobayashi, Takashi Yoshida, Mitsuaki Sato, Yuichiro Suzuki, Nobuyuki Enom
Digestive Diseases and Sciences.2024; 69(3): 969. CrossRef - Partial Stent-in-Stent Method with an Uncovered Self-Expandable Metallic Stent for Unresectable Malignant Hilar Bile Duct Obstruction
Takuya Shimosaka, Yohei Takeda, Taro Yamashita, Yuta Seki, Shiho Kawahara, Takayuki Hirai, Noriyuki Suto, Yuri Sakamoto, Wataru Hamamoto, Hiroki Koda, Takumi Onoyama, Kazuya Matsumoto, Kazuo Yashima, Hajime Isomoto, Naoyuki Yamaguchi
Journal of Clinical Medicine.2024; 13(3): 820. CrossRef - Current status of preoperative endoscopic biliary drainage for distal and hilar biliary obstruction
Hirotoshi Ishiwatari, Junya Sato, Hiroki Sakamoto, Takuya Doi, Hiroyuki Ono
Digestive Endoscopy.2024; 36(9): 969. CrossRef - Biliary drainage in hilar and perihilar cholangiocarcinoma: 25-year experience at a tertiary cancer center
Ahmad Al Nakshabandi, Faisal S. Ali, Iyad Albustami, Hyunsoo Hwang, Wei Qiao, Nicole C. Johnston, Abdullah S. Shaikh, Emmanuel Coronel, Phillip S. Ge, William Ross, Brian Weston, Jeffrey H. Lee
Gastrointestinal Endoscopy.2024; 99(6): 938. CrossRef - Safety and efficacy of biliary suprapapillary metal and plastic stents in malignant biliary obstruction: a systematic review and meta-analysis
Saqr Alsakarneh, Mahmoud Y. Madi, Fouad Jaber, Kamal Hassan, Yassine Kilani, Omar Al Ta’ani, Dushyant Singh Dahiya, Amir H. Sohail, Laith Numan, Mohammad Bilal, Wissam Kiwan
Surgical Endoscopy.2024; 38(8): 4186. CrossRef - Clinical Outcomes of Inside Stents and Conventional Plastic Stents as Bridge-to-Surgery Options for Malignant Hilar Biliary Obstruction
Hirotoshi Ishiwatari, Takanori Kawabata, Hiroki Kawashima, Yousuke Nakai, Shin Miura, Hironari Kato, Hideyuki Shiomi, Nao Fujimori, Takeshi Ogura, Osamu Inatomi, Kensuke Kubota, Toshio Fujisawa, Mamoru Takenaka, Hiroshi Mori, Kensaku Noguchi, Yuki Fujii,
Digestive Diseases and Sciences.2023; 68(4): 1139. CrossRef - Development of novel biliary metal stent with coil-spring structure and its application in vivo swine biliary stricture model
In Rae Cho, Sang Hyub Lee, Jin Ho Choi, Namyoung Park, Min Woo Lee, Joo Seong Kim, Seok Jeong, Don Haeng Lee, Tae-Won Jeong, Byoung-Yun Ki, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim
Frontiers in Oncology.2023;[Epub] CrossRef - Endoscopic retrograde stent drainage therapies for malignant biliary obstruction: the distal opening of stent location above or across the duodenal papilla? A systematic review and meta-analysis
Dong Fang, Yi Han, Chenglin Zhu, Zhenwang Shi, Deming Bao, Liming Wang, Qin Xu
Scandinavian Journal of Gastroenterology.2023; 58(9): 1071. CrossRef - Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: a multicenter, randomized trial
Yoshihide Kanno, Kei Ito, Kazunari Nakahara, Shinya Kawaguchi, Yoshiharu Masaki, Toru Okuzono, Hironari Kato, Masaki Kuwatani, Shotaro Ishii, Toji Murabayashi, Sho Hasegawa, Masatsugu Nagahama, Yuji Iwashita, Yosuke Michikawa, Shuzo Terada, Yujiro Kawakam
Gastrointestinal Endoscopy.2023; 98(2): 211. CrossRef - Déjà vu but with a different conclusion
Richard Kozarek
Gastrointestinal Endoscopy.2023; 98(5): 787. CrossRef - Utility of bilateral intraductal plastic stent for malignant hilar biliary obstruction compared with bilateral self-expandable metal stent: a propensity score–matched cohort analysis
Mitsuru Okuno, Keisuke Iwata, Takuji Iwashita, Tsuyoshi Mukai, Kota Shimojo, Yosuke Ohashi, Yuhei Iwasa, Akihiko Senju, Shota Iwata, Ryuichi Tezuka, Hironao Ichikawa, Naoki Mita, Shinya Uemura, Kensaku Yoshida, Akinori Maruta, Eiichi Tomita, Ichiro Yasuda
Gastrointestinal Endoscopy.2023; 98(5): 776. CrossRef - Cross‐wired metal stents for endoscopic bilateral stent‐in‐stent deployment in malignant hilar biliary obstruction: A multicenter, single‐arm, prospective study
Kentaro Yamao, Takeshi Ogura, Hideyuki Shiomi, Takaaki Eguchi, Hisakazu Matsumoto, Zhao Liang Li, Hiroaki Hashimoto, Yasutaka Chiba, Mamoru Takenaka, Tomohiro Watanabe, Masatoshi Kudo, Tsuyoshi Sanuki
DEN Open.2022;[Epub] CrossRef - Recent advances regarding endoscopic biliary drainage for unresectable malignant hilar biliary obstruction
Hironari Kato, Kazuyuki Matsumoto, Hiroyuki Okada
DEN Open.2022;[Epub] CrossRef - Double‐scope method is helpful to rescue a retrieval thread attached to a stent caught on the duodenoscope forceps elevator
Kengo Matsumoto, Dai Nakamatsu, Tsutomu Nishida
Digestive Endoscopy.2022;[Epub] CrossRef - The feasibility of percutaneous transhepatic gallbladder aspiration for acute cholecystitis after self-expandable metallic stent placement for malignant biliary obstruction: a 10-year retrospective analysis in a single center
Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Masayuki Hijioka, Ken Kawabe, Naohiko Harada, Makoto Nakamuta, Takamasa Oono, Yoshihiro Ogawa
Clinical Endoscopy.2022; 55(6): 784. CrossRef - Self‐expandable metal stents have longer patency and less cholangitis than inside stents in malignant perihilar biliary obstruction
Akinobu Koiwai, Morihisa Hirota, Tomofumi Katayama, Ryo Kin, Keita Kawamura, Katsuya Endo, Takayuki Kogure, Atsuko Takasu, Takayoshi Meguro, Kennichi Satoh
JGH Open.2022; 6(5): 317. CrossRef - Two-devices-in-one-channel method for preventing the preceding stent migration in case of multiple indwelling biliary inside plastic stents
Tesshin Ban, Yoshimasa Kubota, Takuya Takahama, Shun Sasoh, Tomoaki Ando, Makoto Nakamura, Takashi Joh
Endoscopy.2022; 54(S 02): E948. CrossRef - Editors' Choice of Noteworthy Clinical Endoscopy Publications in the First Decade
Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
Clinical Endoscopy.2021; 54(5): 633. CrossRef - Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how?
Tudor Mocan, Adelina Horhat, Emil Mois, Florin Graur, Cristian Tefas, Rares Craciun, Iuliana Nenu, Mihaela Spârchez, Zeno Sparchez
World Journal of Gastrointestinal Oncology.2021; 13(12): 2050. CrossRef - Changing Trends in Biliary Stenting for Unresectable Malignant Perihilar Obstructions
Lubna Kamani, Muhammad Arshad
Clinical Endoscopy.2020; 53(6): 636. CrossRef
- Efficacy of Drainage Combining Endoscopic Retrograde Cholangiopancreatography With Endoscopic Ultrasound‐guided Biliary Drainage for Difficult‐to‐Control Cholangitis in Patients With Hilar Cholangiocarcinoma
- 10,102 View
- 306 Download
- 28 Web of Science
- 29 Crossref
- Predictive Value of Localized Stenosis of the Main Pancreatic Duct for Early Detection of Pancreatic Cancer
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Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Yujiro Kawakami, Yuki Fujii, Kazuaki Miyamoto, Toji Murabayashi, Fumisato Kozakai, Jun Horaguchi, Yutaka Noda, Masaya Oikawa, Takaho Okada, Kei Ito
- Clin Endosc 2019;52(6):588-597. Published online November 20, 2019
- DOI: https://doi.org/10.5946/ce.2019.018
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Abstract
PDF
- Background
/Aims: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) for early detection of pancreatic cancer.
Methods
Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19 patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage (FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) and without other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmune pancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of >5 years.
Results
Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. The final diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, and to be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%, and 88%, respectively.
Conclusions
The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juice cytology is necessary before surgical resection. -
Citations
Citations to this article as recorded by- Clinical and imaging differences between pancreatic carcinoma in situ and T1a/T1b pancreatic ductal adenocarcinoma
Tatsunori Satoh, Shinya Kawaguchi, Eiji Nakatani, Haruna Takahashi, Shinya Endo, Naofumi Shirane, Hideyuki Kanemoto, Kazuya Ohno
Abdominal Radiology.2026; 51(9): 4456. CrossRef - Super-resolution deep learning–enhanced 2D MRCP improves main pancreatic duct visualization compared with 3D MRCP
Kumi Ozaki, Shoya Haseyama, Eri Sugioka, Yukichi Tanahashi, Satoshi Goshima
European Journal of Radiology.2026; 203: 113022. CrossRef - Semiannual surveillance facilitates detection of surgically treatable intraductal papillary mucinous neoplasm–derived and concomitant carcinoma: a multicenter prospective observational study
Yosuke Ohashi, Akinori Maruta, Takuya Koizumi, Shota Iwata, Shinya Uemura, Ryuichi Tezuka, Yuhei Iwasa, Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Hironao Ichikawa, Naoki Mita, Kensaku Yoshida, Takuji Iwashita, Masahito Shimizu
Pancreatology.2026; 26(5): 738. CrossRef - Clinicopathologic Outcomes After Resection of Suspected High-Grade Pancreatic Intraepithelial Neoplasia Without Invasive Carcinoma: A Multicenter Retrospective Study
Takuya Mizumoto, Yoshihide Nanno, Jun Ishida, Katsuya Ami, Kei Yamane, Yuichiro Uchida, Takeshi Takahara, Kazuyuki Nagai, Ippei Matsumoto, Takumi Fukumoto
Annals of Surgical Oncology.2026;[Epub] CrossRef - Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage catheter combined with clinical findings improves diagnostic ability for malignant cases of suspected pancreatic cancer with non-identifiable tumors
Tatsunori Satoh, Junichi Kaneko, Eiji Nakatani, Hirotoshi Ishiwatari, Junya Sato, Akihiko Ohata, Reiko Yamada, Tetsuro Miwata, Kazuma Ishikawa, Fumitaka Niiya, Yosuke Kobayashi, Yasushi Hamaya, Jun Ito, Kazuhito Kawata, Azumi Suzuki, Yasunari Sakamoto, Yu
Pancreatology.2025; 25(1): 125. CrossRef - Perilesional branch duct dilation as a hallmark MRCP feature for differentiating high-grade PanIN from low-grade PanIN
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Endoscopy International Open.2025;[Epub] CrossRef - Efficient Assessment of Tumor Vascular Shutdown by Photodynamic Therapy on Orthotopic Pancreatic Cancer Using High-Speed Wide-Field Waterproof Galvanometer Scanner Photoacoustic Microscopy
Jaeyul Lee, Sangyeob Han, Til Bahadur Thapa Magar, Pallavi Gurung, Junsoo Lee, Daewoon Seong, Sungjo Park, Yong-Wan Kim, Mansik Jeon, Jeehyun Kim
International Journal of Molecular Sciences.2024; 25(6): 3457. CrossRef - Role of endoscopic retrograde cholangiopancreatography in early diagnosis of pancreatic cancer
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Clinical Endoscopy.2019; 52(6): 523. CrossRef
- Clinical and imaging differences between pancreatic carcinoma in situ and T1a/T1b pancreatic ductal adenocarcinoma
- 9,117 View
- 135 Download
- 18 Web of Science
- 19 Crossref
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