1) The reference lists of these included articles were manually

1). The reference lists of these included articles were manually screened, but they did not yield additional studies. After excluding 17 duplications, a total of 21 articles were included for further synthesis.6, 7, 8, 9, 10, 11, 12, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 and 43 No randomized or nonrandomized, controlled trials were identified. Of the 21 included PD-166866 studies, 9 used a prospective case series design8, 11, 30, 32, 33, 34, 35, 36 and 38; the remaining 12 studies used a retrospective case series approach. Eight studies used MPSs after OLT,6, 7, 8, 9, 10, 11, 12 and 37 3 studies used MPSs after LDLT,41, 42 and 43 whereas 10 studies used SEMSs after OLT

for ABSs. No study using SEMSs after LDLT was identified. The 5 most important criteria in the Centre for Reviews and Dissemination quality assessment checklist primarily addressed selection bias (eligibility criteria, consecutive cases), attrition bias (patient follow-up), and detection bias (prospective design).28 In the studies that we identified, patient inclusion and exclusion criteria were clearly reported in all but 2 studies.31 and 35 Consecutive enrollment of cases was clearly reported in only 4 studies.32, 34, 35 and 38 All 21 studies followed 100% of the included patients. Clear descriptions of study design with inclusion and exclusion Fluorouracil chemical structure criteria were provided in 13 of the 21 studies.6, 7, 8, 9, 10, 11, 12, 30, 37, 39, 40, 41 and 43

None of the studies met all 5 criteria, thus reaching a quality rating of “poor.” Nine studies met 4 of 5 criteria,8, 9, 11, 30, 32, 34, 35, 38 and 43 11 studies met 3 of 5 criteria,6, 7, 10, 12, 33, 36, 37, 39, 40, 41 and 42 and 1 study met 2 of 5 criteria.31 Patient baseline characteristics and outcomes are summarized in Table 1 (OLT), Table 2 (LDLT) for MPSs, and Table 3 for SEMS studies. There

was significant heterogeneity in primary outcomes, such as stricture resolution rates, stent removability, Benzatropine and stent patency rates. The stent protocols, including the diameter of PSs, diameter of the dilating balloon used, number of side-by-side PSs placed, number of BDs or stent exchanges performed, the interval between stent exchanges, overall duration of stent placement, and stent-free follow-up, varied significantly in MPS studies. There was also heterogeneity in the types of SEMSs used, the use of BD or MPSs and duration before SEMS placement, overall stent duration, and stent-free follow-up in SEMS studies. The various stent protocols are summarized in Table 4. Eight studies used MPSs to treat a total of 440 OLT patients.6, 7, 8, 9, 10, 11, 12 and 37 Overall technical success rates were high, ranging from 92% to 100%. The stent exchange interval was approximately 3 months in most studies, except for that in the study by Morelli et al,8 who used an exchange interval of 2 weeks. The mean or median number of stents per ERCP was between 2 and 3.

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