What does this research mean for the field?

Multi-hole covered self-expandable metal stents (MHSEMS) significantly reduce the incidence of cholecystitis and stent migration, and prolong the time to recurrent biliary obstruction compared to conventional covered stents in patients with malignant distal biliary obstruction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the clinical efficacy and safety of multi-hole covered self-expandable metal stents compared to conventional covered metal stents in malignant distal biliary obstruction, including an evaluation of 6-mm devices.

August 27, 2026DEN OpenOpen Access

Clinical Outcomes of Multi‐Hole Covered Self‐Expandable Metal Stents for Malignant Distal Biliary Obstruction: A Retrospective Comparative Study With an Exploratory Evaluation of 6‐mm Devices

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Authors

AKAkinobu KoiwaiTohoku Medical and Pharmaceutical University Hospital YMYuki MiyashitaTohoku Medical and Pharmaceutical University Hospital NINana InomataTohoku Medical and Pharmaceutical University Hospital

Discussion

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Implication

Retrospective study demonstrates multi-hole covered metal stents reduce cholecystitis and extend patency in malignant distal biliary obstruction, indicating effective side-branch preservation.

Key Points

To assess the clinical efficacy and safety of multi-hole covered self-expandable metal stents compared to conventional covered metal stents in malignant distal biliary obstruction, including an evaluation of 6-mm devices.
Retrospective single-center study of consecutive patients undergoing initial transpapillary SEMS placement for malignant distal biliary obstruction between September 2015 and December 2025.
Study-I compared 8–10 mm multi-hole SEMS versus conventional covered SEMS (N=148); Study-II compared 6-mm versus 8–10 mm multi-hole SEMS (N=64).
Assessed rates of cholecystitis, post-ERCP pancreatitis, recurrent biliary obstruction (RBO), time to RBO, and stent migration.
In Study-I, multi-hole SEMS significantly reduced cholecystitis compared to conventional stents (1/34 vs 23/98, p=0.008; OR 0.0879, 95% CI 0.0111–0.696) and significantly lengthened time to recurrent obstruction (log-rank p=0.023).
Recurrent biliary obstruction occurred in 1/36 multi-hole SEMS cases versus 28/112 conventional stent cases, with zero stent migrations versus 9 in the conventional group, while post-ERCP pancreatitis did not differ significantly (4/36 vs 18/112, p=0.595).
In Study-II, post-ERCP pancreatitis occurred in 1/28 with 6-mm devices versus 4/36 with 8–10 mm devices (p=0.375), with RBO occurring in 1/28 versus 1/36 and no migrations observed.

Cite This Study

Koiwai et al. (2026) studied this question.

synapsesocial.com/papers/6a8fe9b910c91c1e926219cb https://doi.org/10.1002/deo2.70411

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Implication

Retrospective study demonstrates multi-hole covered metal stents reduce cholecystitis and extend patency in malignant distal biliary obstruction, indicating effective side-branch preservation.

Clinical Outcomes of Multi‐Hole Covered Self‐Expandable Metal Stents for Malignant Distal Biliary Obstruction: A Retrospective Comparative Study With an Exploratory Evaluation of 6‐mm Devices

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Cite This Study

Clinical Outcomes of Multi‐Hole Covered Self‐Expandable Metal Stents for Malignant Distal Biliary Obstruction: A Retrospective Comparative Study With an Exploratory Evaluation of 6‐mm Devices

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Cite This Study

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