Pitfalls and promises of bile duct alternatives: A narrative review

Table 3 Bile duct substitute using bioabsorbable material

Ref.	Journal	Substitute	Stent	Animal type (n)	Size of BDS (cm)	Method of reconstruction of bile duct by BDS (n)	Observation period after implantation	Localization of regenerated bile duct	Causes of stenosis	Note (planned sacrificial death and epithelialization)
Rosen et al[24], 2002	Surgery	SIS	(-)	Dog (15)	Patch: (2.0 cm × 1.0 cm), ring: (2.0-3.0)	Patch (9), CBC (6)	Maximum 5 mo	BDS itself	Scar contraction at the site of anastomosis on the duodenal side	Thirteen out of 15 dogs were intentionally killed. The regenerated bile duct tissue was shown consequently, and the process of regenerating the bile duct was not shown
Miyazawa et al[25], 2005	Am J Transplant	P (CL/LLA) with PGA	(-)	Pig (18)	Ring (3.0)	CBJ (18)	Maximum 6 mo	BDS outside	No narrowed BDS	All pigs were intentionally killed. A good bile duct regeneration process was shown
Nau et al[26], 2011	HPB (Oxford)	PGA and TMC	5 Fr pancreatic stent	Dog (11)	Ring (1.0)	CBC (11)	Maximum 12 mo	BDS itself	Narrowing of the BDS lumen	Ten out of 11 dogs were intentionally killed. No good bile duct epithelial regeneration was observed
Li et al[27], 2012	Biomaterials	Collagen with bFGF	(-)	Pig (26)	Patch (2.0 cm × 1.0 cm)	Patch (26)	Maximum 6 mo	BDS itself	No narrowed BDS	All pigs were intentionally killed. The regenerated bile duct tissue was shown consequently, while the process of regenerating the bile duct was not shown
Tao et al[28], 2015	Artif Organs	Collagen	Plastic stent	Pig (20)	Patch (2.0 cm × 0.6 cm)	Patch (12)	Maximum 12 wk	BDS itself	No narrowed BDS	All pigs were intentionally killed. The regenerated bile duct tissue was observed consequently, while the process of regenerating the bile duct was not shown
Tanimoto et al[62], 2016	Langenbecks Arch Surg	P (CL/LLA)	T-tube	Pig (11)	Ring (2.0)	CBC (11)	Maximum 6 mo	BDS itself	No narrowed BDS	All pigs were intentionally killed. A high degree of fibrosis was observed in the regenerated bile duct tissue
de Abreu et al[63], 2020	J Biomater Appl	Bacterial cellulose film	T-tube	Pig (10)	Patch (2.0 cm × 1.0 cm)	CBC (20)	Maximum 330 d	BDS itself	No narrowed BDS	All pigs were intentionally killed. No process of bile duct regeneration was shown

BDS: Bile duct substitute; bFGF: Basic fibroblast growth factor; CBC: Common bile duct to bile duct substitute to common bile duct; CBJ: Common bile duct to bile duct substitute to jejunum; P(CL/LLA): Polyε-caprolactone/poly l-lactide; PGA: Polyglycolic acid; SIS: Small intestinal submucosa; TMC: Trimethylene carbonate.