OBJECTIVES: Although fully covered self-expandable metal stents (FCSEMS) are used for the management of anastomotic biliary stricture (ABS) after liver transplantation (LT), there is concern about long-term adverse events such as recurrence of stricture. We evaluated the long-term efficacy of a modified nonflared FCSEMS (M-FCSEMS) compared to plastic stents (PS) for refractory ABS after LT. METHODS: Consecutive patients who underwent placement of an M-FCSEMS (M-FCSEMS group) or multiple PS (PS group) for refractory ABS after LT were enrolled. The primary outcome was the stricture recurrence rate, and the secondary outcomes were technical success, clinical success, and the rate of de novo stricture. RESULTS: In both groups, technical success was achieved in all patients. The median stent duration was 3.1 months in the M-FCSEMS group and 7.6 months in the PS group (P <
0.001). Clinical success rates were 96.7% (29/30) for the M-FCSEMS group and 94.4% (17/18) for the PS group (P = 0.709). Stent migration occurred in 10.0% (3/30) of the patients before removal of the stent in the M-FCSEMS group, while 27.8% (5/18) of patients in the PS group showed stent migration (P = 0.110). Stricture recurrence occurred in 17.2% (5/29) in the M-FCSEMS group, compared to 47.1% (8/17) in the PS group (P = 0.036). There were no de novo strictures observed in either cohort. CONCLUSION: Modified nonflared FCSEMS is effective for relieving refractory ABS after LT, with a low recurrence rate and the absence of de novo stricture after long-term follow-up.