{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:03:18Z","timestamp":1784538198010,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Benign biliary anastomotic strictures (BAS) remain among the most frequent complications after living donor liver transplantation (LDLT). Although multiple plastic stents (MPS) have traditionally been considered the standard endoscopic treatment, fully covered self-expandable metal stents (FCSEMS) and intraductal fully covered self-expandable metal stents (ID-FCSEMS) have emerged as alternative strategies. This study aimed to compare the efficacy and safety of MPS, FCSEMS, and ID-FCSEMS in the management of post-transplant biliary anastomotic strictures. Methods: This retrospective single-center cohort study included consecutive adult patients who developed benign biliary anastomotic strictures after LDLT and underwent ERCP-based treatment between January 2020 and January 2025. Patients were categorized according to the initial stent strategy: MPS (n = 32), FCSEMS (n = 30), and ID-FCSEMS (n = 25). Primary outcome was overall treatment success. Secondary outcomes included recurrence, number of ERCP sessions, treatment duration, post-procedural hospitalization, stent migration, and procedure-related adverse events. Results: A total of 87 patients were included. Clinical success was achieved in 81.3% of patients treated with MPS, 83.3% treated with FCSEMS, and 92.0% treated with ID-FCSEMS (p = 0.501). Recurrence rates were 18.8%, 10.0%, and 12.0%, respectively (p = 0.579). Patients treated with metal stents required significantly fewer ERCP sessions than those treated with MPS (median 5 vs. 2 vs. 2; p &lt; 0.001). Median treatment duration was significantly shorter in the FCSEMS and ID-FCSEMS groups compared with the MPS group (12 vs. 10 vs. 9 months; p &lt; 0.001). Post-procedural hospitalization was also reduced with metal stents (7 vs. 4 vs. 3 days; p &lt; 0.001). Adverse event rates, including cholangitis, pancreatitis, bleeding, perforation, and mortality, were comparable among groups. Stent migration occurred in 21.9% of MPS patients, 23.3% of FCSEMS patients, and 12.0% of ID-FCSEMS patients (p = 0.525). On multivariable analysis, MELD score was the only independent predictor of treatment success (adjusted OR 0.90, 95% CI 0.83\u20130.98; p = 0.012). Conclusions: MPS, FCSEMS, and ID-FCSEMS achieved comparable rates of stricture resolution, recurrence, and adverse events in the treatment of biliary anastomotic strictures after LDLT. However, FCSEMS and ID-FCSEMS significantly reduced the number of ERCP procedures, treatment duration, and hospitalization compared with conventional plastic stenting. Among the evaluated strategies, ID-FCSEMS demonstrated the highest numerical success rate and lowest migration rate, suggesting a potential procedural advantage while maintaining comparable safety and efficacy.<\/jats:p>","DOI":"10.3390\/jcm15145641","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:54:13Z","timestamp":1784534053000},"page":"5641","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Plastic, Fully Covered Metal, and Intraductal Metal Stents for Biliary Anastomotic Strictures After Living Donor Liver Transplantation: A Single-Center Experience"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7642-2793","authenticated-orcid":false,"given":"\u00d6mer","family":"K\u00fc\u00e7\u00fckdemirci","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, School of Medicine, Ondokuz May\u0131s University, 55100 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0652-2147","authenticated-orcid":false,"given":"Berk","family":"Ba\u015f","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, School of Medicine, Ayd\u0131n Adnan Menderes University, 09100 Ayd\u0131n, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"ref_1","first-page":"100593","article-title":"Diagnosis and management of benign biliary strictures post liver transplantation in adults","volume":"34","author":"Keane","year":"2020","journal-title":"Transplant. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.3748\/wjg.v24.i19.2061","article-title":"Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions","volume":"24","author":"Rao","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.3748\/wjg.v22.i4.1593","article-title":"Current diagnosis and treatment of benign biliary strictures after living donor liver transplantation","volume":"22","author":"Chang","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5009\/gnl.2011.5.2.133","article-title":"Biliary strictures after liver transplantation","volume":"5","author":"Ryu","year":"2011","journal-title":"Gut Liver"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1002\/lt.25358","article-title":"Endoscopic management of benign biliary strictures after liver transplantation","volume":"25","author":"Larghi","year":"2019","journal-title":"Liver Transplant."},{"key":"ref_6","first-page":"316","article-title":"Management of biliary strictures after liver transplantation","volume":"11","author":"Villa","year":"2015","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101186","DOI":"10.1016\/j.aohep.2023.101186","article-title":"A practical approach to the endoscopic management of biliary strictures after liver transplantation","volume":"29","author":"Bofill","year":"2024","journal-title":"Ann. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.trre.2017.03.002","article-title":"Management of biliary anastomotic strictures after liver transplantation","volume":"31","author":"Koksal","year":"2017","journal-title":"Transplant. Rev."},{"key":"ref_9","first-page":"12","article-title":"Post-transplant biliary strictures: An updated review","volume":"57","author":"Fasullo","year":"2024","journal-title":"Clin. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/s12664-022-01245-4","article-title":"Anastomotic biliary stricture following liver transplantation and management analysis: 15 years of experience at a high-volume transplant center","volume":"41","author":"Eslami","year":"2022","journal-title":"Indian J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gheorghe, G., Diaconu, C.C., Bungau, S., Bacalbasa, N., Motas, N., and Ionescu, V.A. (2023). Biliary and vascular complications after liver transplantation\u2014From diagnosis to treatment. Medicina, 59.","DOI":"10.3390\/medicina59050850"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.gie.2022.08.034","article-title":"Scheduled endoscopic treatment of biliary anastomotic and nonanastomotic strictures after orthotopic liver transplantation","volume":"97","author":"Zhang","year":"2023","journal-title":"Gastrointest. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.gie.2013.01.015","article-title":"Managing the post-liver transplantation anastomotic biliary stricture: Multiple plastic versus metal stents: A systematic review","volume":"77","author":"Kao","year":"2013","journal-title":"Gastrointest. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1016\/j.gie.2008.09.057","article-title":"Endoscopic treatment with multiple stents for post-liver-transplantation nonanastomotic biliary strictures","volume":"69","author":"Tabibian","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s00464-024-11467-6","article-title":"Fully covered self-expandable metal stents versus multiple plastic stents for the treatment of post-orthotopic liver transplant anastomotic biliary strictures: An updated systematic review and meta-analysis of randomized controlled trials","volume":"39","author":"Baraldo","year":"2025","journal-title":"Surg. Endosc."},{"key":"ref_16","first-page":"668","article-title":"Post-transplant biliary complications: Advances in pathophysiology, diagnosis, and treatment","volume":"57","author":"Fasullo","year":"2024","journal-title":"Clin. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"66","DOI":"10.4254\/wjh.v13.i1.66","article-title":"Post-liver transplant biliary complications: Current knowledge and therapeutic advances","volume":"13","author":"Boeva","year":"2021","journal-title":"World J. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/MCG.0b013e31827fd311","article-title":"Multicenter trial evaluating the use of covered self-expanding metal stents in benign biliary strictures: Time to revisit our therapeutic options?","volume":"47","author":"Kahaleh","year":"2013","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1053\/j.gastro.2014.04.043","article-title":"Successful management of benign biliary strictures with fully covered self-expanding metal stents","volume":"147","author":"Reddy","year":"2014","journal-title":"Gastroenterology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2510","DOI":"10.1016\/j.transproceed.2016.09.008","article-title":"Endoscopic management of post-liver transplantation biliary strictures with the use of fully covered metallic stents","volume":"48","author":"Manteca","year":"2016","journal-title":"Transplant. Proc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1055\/s-0031-1291465","article-title":"Fully covered metallic stents in biliary stenosis after orthotopic liver transplantation","volume":"44","author":"Tarantino","year":"2012","journal-title":"Endoscopy"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.gie.2022.10.007","article-title":"American Society for Gastrointestinal Endoscopy guideline on management of post-liver transplant biliary strictures: Summary and recommendations","volume":"97","author":"Kohli","year":"2023","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2023). Cochrane Handbook for Systematic Reviews of Interventions. Version 6.4, Cochrane."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat. Methods Med. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.gie.2022.11.018","article-title":"Intraductal fully covered self-expandable metal stent versus multiple plastic stents for treating biliary anastomotic strictures after liver transplantation","volume":"97","author":"Sissingh","year":"2023","journal-title":"Gastrointest. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1067\/mge.2003.11","article-title":"Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation","volume":"57","author":"Park","year":"2003","journal-title":"Gastrointest. Endosc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1002\/lt.20644","article-title":"Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation","volume":"12","author":"Graziadei","year":"2006","journal-title":"Liver Transplant."},{"key":"ref_29","first-page":"910","article-title":"Endoscopic biliary stenting: Indications, choice of stents, and results: ESGE guideline","volume":"50","author":"Dumonceau","year":"2018","journal-title":"Endoscopy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"131.e1","DOI":"10.1016\/j.gie.2017.04.013","article-title":"Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: A randomized controlled trial","volume":"87","author":"Martins","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1001\/jama.2016.2619","article-title":"Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: A randomized clinical trial","volume":"315","author":"Slivka","year":"2016","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1002\/lt.21165","article-title":"Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression","volume":"13","author":"Verdonk","year":"2007","journal-title":"Liver Transpl."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/j.gie.2017.03.009","article-title":"Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: A prospective randomized multicenter trial","volume":"86","author":"Tal","year":"2017","journal-title":"Gastrointest. Endosc."},{"key":"ref_34","first-page":"407","article-title":"Multiple plastic versus fully covered metal stents for managing post-liver transplantation anastomotic biliary strictures: A meta-analysis of randomized controlled trials","volume":"32","author":"Tringali","year":"2019","journal-title":"Ann. Gastroenterol."},{"key":"ref_35","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_36","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1002\/hep.1840170413","article-title":"Diagnostic features and clinical outcome of ischemic-type biliary complications after liver transplantation","volume":"17","author":"Gores","year":"1993","journal-title":"Hepatology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1097\/HEP.0000000000000873","article-title":"The future of liver transplantation","volume":"80","author":"Feng","year":"2024","journal-title":"Hepatology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"20543581231178960","DOI":"10.1177\/20543581231178960","article-title":"The Impact of Combined Warm and Cold Ischemia Time on Post-transplant Outcomes","volume":"10","author":"Foley","year":"2023","journal-title":"Can. J. Kidney Health Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"719","DOI":"10.12659\/AOT.905331","article-title":"Application of fully covered self-expandable metallic stents with and without antimigration waist versus repeated plastic biliary stent placement in management of anastomotic biliary strictures after orthotopic liver transplantation","volume":"22","author":"Zeair","year":"2017","journal-title":"Ann. Transplant."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1007\/s00464-016-5138-9","article-title":"Success and complications of an intra-ductal fully covered self-expanding metal stent (ID-FCSEMS) to treat anastomotic biliary strictures after orthotopic liver transplantation","volume":"31","author":"Aepli","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.gie.2012.01.016","article-title":"Feasibility of placing a modified fully covered self-expandable metal stent above the papilla to minimize stent-induced bile duct injury in patients with refractory benign biliary strictures","volume":"75","author":"Moon","year":"2012","journal-title":"Gastrointest. Endosc."},{"key":"ref_42","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_43","first-page":"485","article-title":"Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: A systematic review and meta-analysis","volume":"37","author":"Papaefthymiou","year":"2024","journal-title":"Ann. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"6307","DOI":"10.1007\/s00464-021-08456-4","article-title":"Optimal drainage of anastomosis stricture after living donor liver transplantation","volume":"35","author":"Sung","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"747","DOI":"10.4253\/wjge.v7.i7.747","article-title":"Management of liver transplantation biliary stricture: Results from a tertiary hospital","volume":"7","author":"Martins","year":"2015","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/s10620-019-05665-9","article-title":"Self-expandable metallic stent is more cost efficient than plastic stent in treating anastomotic biliary stricture","volume":"65","author":"Jang","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/tri.13867","article-title":"Cost analysis of a long-term randomized controlled study in biliary duct-to-duct anastomotic stricture after liver transplantation","volume":"34","author":"Santi","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1111\/liv.14010","article-title":"Endo-therapies for biliary duct-to-duct anastomotic stricture after liver transplantation: Outcomes of a nationwide survey","volume":"39","author":"Tarantino","year":"2019","journal-title":"Liver Int."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1177\/1756283X16685059","article-title":"Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation","volume":"10","author":"Jang","year":"2017","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e13360","DOI":"10.1111\/tid.13360","article-title":"Pyogenic liver abscess in liver transplant recipients: A warning signal for the risk of recurrence and retransplantation","volume":"22","author":"Lafont","year":"2020","journal-title":"Transpl. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1007\/s10096-018-3333-4","article-title":"Etiologies, risk factors, and outcomes of bacterial cholangitis after living donor liver transplantation","volume":"37","author":"Yao","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1016\/j.dld.2018.05.014","article-title":"Significant infections in liver transplant recipients undergoing ERCP are few and unaffected by prophylactic antibiotics","volume":"50","author":"Kohli","year":"2018","journal-title":"Dig. Liver Dis."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-related adverse events: ESGE Guideline","volume":"52","author":"Dumonceau","year":"2020","journal-title":"Endoscopy"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5641\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:12:45Z","timestamp":1784535165000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,18]]},"references-count":53,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145641"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145641","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,18]]}}}