Previous studies have also found a lower stent migration rate with MPS compared with a single PS and covered SEMS. 26 and 50 Current evidence of BD + MPS in the management of ABSs after LDLT is limited. ABSs after LDLT had predominantly been managed by reoperation or retransplantation in the past because many cases involved Roux-en-Y hepaticojejunostomy and/or multiple anastomoses. Not only are ABSs more common

after LDLT, but also are less likely to respond to BD and stenting than in OLT patients.21, 22, 23 and 51 Most case series used BD only or BD followed by insertion of a single PS, with lower stricture resolution rates compared with ABSs in OLT patients.2 and 52 The index ERCP failed in many patients, and Sorafenib supplier percutaneous transhepatic cholangiography and/or a rendezvous approach to traverse these strictures were required. This may reflect the fact that the donor bile ducts and strictures in the LDLT setting are smaller, anatomically more challenging, and sometimes Dabrafenib molecular weight multiple compared with those seen after OLT. Furthermore, the risks of cholangitis and stent occlusion were found to be substantially higher after LDLT

than after OLT in this review. Therefore, it is difficult to apply the same endoscopic strategy to ABSs in both OLT and LDLT settings and expect similar outcomes. Covered SEMSs, either as primary or secondary therapy, achieved stricture resolution rates very similar to those seen with MPSs. However, this conclusion is limited by the heterogeneity of different types of the SEMSs used in these studies because it is inappropriate

to assume that all SEMSs are equivalent. Furthermore, SEMSs were used as “rescue” therapy in 5 of the 10 studies, introducing a potential selection bias for more difficult strictures. One could speculate Alanine-glyoxylate transaminase that SEMSs would have performed more poorly without previous PSs in these difficult strictures. For instance, the prospective study by Tarantino et al38 reported that the stricture resolution rate was much higher in late ABS after a trial of PS placement for a year, compared with those without previous stenting (72% vs 53%), although the SEMS duration was only 2 months. SEMS duration of at least 3 months appeared to result in higher stricture resolution rates. One significant problem with covered SEMSs is a much higher stent migration rate than for MPSs. Given the small number of patients in these studies, however, it was not clear whether fully covered SEMSs or longer stent durations were predictors of higher stent migration rates. Other studies found a higher stent migration rate with fully covered SEMSs (17%) compared with partially covered SEMSs (7%).26 and 53 Two studies, in fact, used novel covered SEMSs, with features such as double flared ends and a proximal lasso (Hanaro; M.I.