Distributions of PCDD/Fs, PCBs, and PCNs in coastal sediments collected from major industrial bays in South Korea.

Polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs), polychlorinated biphenyls (PCBs), and polychlorinated naphthalenes (PCNs) were assessed in coastal sediments from industrial bays in South Korea to evaluate the pollution levels and their environmental impact. The mean sediment concentrations of Σ17 PCDD/Fs, Σ18 PCBs, and Σ15 PCNs were 198 ± 140, 3427 ± 7037, and 85 ± 336 pg/g dw, respectively. Generally, pollutant concentrations in the inner bay were higher than those in the outer bay, indicating the influence of industrial emissions and harbor activities. The primary sources were identified as steel manufacturing and wastewater treatment plants for PCDD/Fs, harbor and shipbuilding activities for PCBs, and combustion-related sources for PCNs. Notably, PCDD/F concentrations exceeded sediment guideline values. The combined effects of PCDD/Fs and PCBs demonstrated adverse impacts on aquatic organisms. Hence, the release of toxic pollutants into the marine environment could have potential biological effects due to the combined impact of these various compounds.

Impact of community health interventions on maternal and child health indicators in the upper east region of Ghana.

BACKGROUND: This paper reports on results of a health system strengthening implementation research initiative conducted the Upper East Region of northern Ghana. Transformative interventions to accelerate and strengthen the health delivery were implemented that included empowering community leaders and members to actively participate in health delivery, strengthening the referral systems through the provision of community transport systems, providing basic medical equipment to community clinics, and improving the skills of critical health staff through training. METHODS: A mixed method design was used to evaluate the impact of the interventions. A quantitative evaluation employed a flexible research design to test the effects of various component activities of the project. To assess impact, a pre-versus-post randomized cluster survey design was used. Qualitative research was conducted with focus group data and individual in depth interviews to gauge the views of various stakeholders associated with the implementation process. RESULTS: After intervention, significant improvements in key maternal and child health indicators such as antenatal and postnatal care coverage were observed and increases in the proportion of deliveries occurring in health facilities and assisted by skilled health personnel relative to pre-intervention conditions. There was also increased uptake of oral rehydration salts (ORS) for treatment of childhood diarrhoea, as well as marked reductions in the incidence of upper respiratory infections (URI). CONCLUSIONS: A pre-and post-evaluation of impact suggests that the programme had a strong positive impact on the functioning of primary health care. Findings are consistent with the proposition that the coverage and content of the Ghana Community-based Health Planning and Services programme was improved by program interventions and induced discernable changes in key indicators of health system performance.

Specific-accumulation and trophic transfer of UV filters and stabilizers in marine food web.

The occurrence and distribution of benzotriazole UV stabilizers (BUVs) and UV filters in marine environments (sediment and seawater) and 20 biota species in the South Korea were investigated to assess their transfer through the marine food web. The total concentrations in the seawater samples were 4.73-8.60 ng/L for BUVs and 1.20-4.88 ng/L for UV filters; while, the total concentrations in the sediment samples were 0.581-6.62 ng/g dw for BUVs and 1.05-6.79 ng/g dw for UV filters, respectively. The total concentrations of BUVs and UV filters were a little higher in benthic invertebrates (BUVs: 131 ng/g lipid weight [lw], UV filters: 41.7 ng/g lw) than fish (BUVs: 99.2 ng/g lw, UV filters: 28.0 ng/g lw) but there were no statistical differences (Mann-Whitney U test, p > 0.05). UV-326 was dominant (fish: 37.9%, benthic invertebrate: 48.7%) of the total BUVs. While, benzophenone-3 (fish: 34.1%, benthic invertebrate: 40.8%) and ethylhexyl methoxy cinnamate (fish: 41.0%, benthic invertebrate: 37.8%) were the dominant UV filters. The bioaccumulation factor and trophic magnification factor indicated that UV-326 can both bioaccumulate and biomagnify (bioaccumulation factor >5000 and biota-sediment accumulation and trophic magnification factors >1). Several other BUVs were found to be able to either bioaccumulate (UV-320, UV-P, UV-329, and UV-234) or biomagnify (UV-327 and UV-928). Most of the analyzed UV filters were found not to be likely to bioaccumulate.

Decreases in Concentrations and Human Dietary Intakes of Polychlorinated Biphenyls (PCBs) and Polybrominated Diphenyl Ethers (PBDEs) in Korean Seafood Between 2005 and 2017.

Concentrations of polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) were measured in 23 seafood species widely consumed by the Korean population in the periods of 2005-2007, 2010-2011, and 2015-2017. The Σ82PCB (sum of 82 PCB congeners) and Σ19PBDE (sum of 19 PBDE congeners) concentrations in the seafood samples of 2015-2017 were 0.06-6.69 ng/g wet weight and 0.01-1.60 ng/g wet weight, respectively. The Σ82PCB and Σ19PBDE concentrations in the samples were significantly correlated. Elevated PCB and PBDE concentrations were found in fatty fish, such as herring, mackerel, and tuna. The current human intakes of PCBs and PBDEs were much lower than the tolerable daily intake or lowest observed adverse effect level. The levels and human dietary intakes of PCBs and PBDEs in the 2015-2017 survey showed decreases of 17-73% and 57-86%, respectively, compared with those in 2005-2007 and 2010-2011 surveys. This indicates that global bans on PCBs and PBDEs have been effective, and their levels and human exposure to them have been gradually declining.

Contamination characteristics of polycyclic aromatic hydrocarbons in river and coastal sediments collected from the multi-industrial city of Ulsan, South Korea.

River and coastal sediments were collected at 17 stations in Ulsan, the largest industrial city in South Korea, to evaluate the levels, profiles, emission sources, and spatial distribution of polycyclic aromatic hydrocarbons (PAHs). The mean concentration of Σ16 PAHs was 722 ng/g, and fluoranthene was a predominant compound. PAHs with 4-6 rings showed higher proportions than PAHs with 2-3 rings. The stations located near industrial complexes showed elevated levels of indicator compounds for petroleum, coal, coke, and fuel combustion. Therefore, petrochemical industries, coal pier, non-ferrous industries, and vehicles were identified as the emission sources. As industrialization and urbanization progressed, an increase in PAH levels and profile changes were observed as a result of the increasing industrial fuel consumption and the increasing number of vehicles. This is the first study that confirmed the change of PAHs in sediment caused by the change of emission sources over time in Ulsan.

Contamination characteristics of siloxanes in coastal sediment collected from industrialized bays in South Korea.

Siloxanes have been used as chemical additives in various products since the 1940s. They are known to have potentially toxic effects, to be environmentally persistent, and to be bioaccumulative. Previous studies have reported high levels of siloxanes in various environmental matrices. In this study, 6 cyclic siloxanes (D4-D9) and 13 linear siloxanes (L3-L15) in coastal sediment collected from southeastern bays adjacent to industrial zones in South Korea (Busan, Ulsan, Jinhae, and Gwangyang) were analyzed. The contamination levels and spatial distribution of siloxanes in the coastal sediment samples were investigated, with the hazard quotients (HQs) for siloxanes evaluated using Monte Carlo simulation. Across all samples, the total concentration (Σ19) of siloxanes was in the range of 11.6-3877 (mean: 305; median: 133) ng/g dry weight (dw). The highest average concentration of Σ19 siloxanes was found in Busan (mean: 580; median: 233 ng/g dw), followed by Ulsan (mean: 316; median: 209 ng/g dw), Jinhae (mean: 266; median: 125 ng/g dw), and Gwangyang (mean: 33; median: 27 ng/g dw), all of which are suggested to be affected by both industrial and domestic activities. The highest contributions were from D5 (18%) and D6 (34%), followed by D9 (7.3%) and L11 (5.8%). The HQs for siloxanes were less than 1, indicating that there was no risk to benthic organisms in the study areas; however, further monitoring of various environmental matrices is required to fully assess the potential ecological risks.

Species and habitat-dependent accumulation and biomagnification of brominated flame retardants and PBDE metabolites.

The occurrence, species- and habitat-dependent distribution of brominated flame retardants (BFRs) and PBDE metabolites comprising 27 polybrominated diphenyl ethers (PBDEs), 3 hexabromocyclododecanes (HBCDs), tetrabromobisphenol A (TBBPA), 17 methoxylated (MeO-) BDEs, and 8 hydroxylated (OH-) BDEs were determined in marine environments (sediment and seawater) and 20 biota species in food web in the southern part of Korea. The concentration of HBCDs was statistically higher in both pelagic (5.73-60.1 ng/g lipid weight [lw]) and demersal fish (2.45-31.3 ng/g lw), whereas a higher level of OH-BDEs was observed in benthic invertebrates (2.48-40.7 ng/g lw), suggesting different composition of BFRs and PBDE metabolites between species. The concentrations of TBBPA and MeO-BDEs were significantly higher in pelagic fish (1.31-11.3, 6.15-61.5 ng/g lw) than in demersal fish (not detected [N.D.]-4.45, 0.956-8.52 ng/g lw) and benthic invertebrates (N.D.-8.11, 0.182-4.65 ng/g lw), reflecting a dependence on habitat. Additionally, analogue distribution of PBDEs in pelagic fish was similar to that in seawater, whereas the distribution in demersal fish and benthic invertebrates was similar to the distribution in sediment. The bioconcentration factor (BCF) and trophic magnification factor (TMF) of α-HBCD, some of PBDEs, and 6-MeO-BDE47 were up to 5000 and 1, respectively, suggesting strong bioaccumulation and biomagnification.

PBDEs and their structural analogues in marine environments: Fate and expected formation mechanisms compared with diverse environments.

The concentrations and relative distributions of 27 polybrominated diphenyl ethers (PBDEs) and 17 methoxylated (MeO-) and 8 hydroxylated (OH-) BDEs were determined in marine environments including sediments, bivalves, and seawater along the southern coast of South Korea to understand their fates and possible formation mechanisms. The relative and substituent distributions of the PBDEs and their structural analogues varied according to the characteristics of the media. PBDEs were dominant in marine sediments and seawater, whereas MeO-BDEs made the highest contributions in bivalves. Similar patterns were previously identified in inland environments in Korea, except in river water where OH-BDEs were dominant. The natural formation of structural analogues might be the main mechanism in marine, as ortho-substituted naturally occurring MeO- and OH-BDEs were dominant in all media and seemed to be more produced than in inland environments. In addition, the higher concentrations of meta-substituted MeO-BDEs nearshore than offshore was observed. This is the first study comparing marine (near- and offshore) and inland to understand the differences in their fate and possible formation mechanisms in each environmental conditions.

Circadian Rhythm of Wrist Temperature among Shift Workers in South Korea: A Prospective Observational Study.

Background: Human body temperature varies with circadian rhythm. To determine the effect of shift work on the circadian rhythm of the distal-skin temperature, wrist temperatures were measured. Methods: Wrist-skin temperatures were measured by an iButton® Temperature Logger. It was measured every 3 min for two and eight consecutive working days in the day and shift workers, respectively. Mesor, amplitude, and acrophase were measured by Cosinor analysis. Results: The shift-worker amplitude dropped significantly as the night shift progressed (0.92 to 0.85 °C), dropped further during rest (0.69 °C), and rose during the morning-shift days (0.82 °C). Day workers still had higher amplitudes (0.93 °C) than the morning-shift workers. The acrophase was delayed during the four night-shift days, then advanced during rest days and the morning-shift days. Nevertheless, the morning-shift worker acrophase was still significantly delayed compared to the day workers (08:03 a.m. vs. 04:11 a.m.). Conclusions: The further reduction of wrist-temperature amplitude during rest after the night shift may be due to the signal circadian rhythm disruption. Reduced amplitudes have been reported to be associated with intolerance to shift work. The findings of our study may help to design the most desirable schedule for shift workers.

Brominated flame retardants in marine environment focused on aquaculture area: Occurrence, source and bioaccumulation.

Brominated flame retardants (BFRs), including polybrominated diphenyl ethers (PBDEs), tetrabromobisphenol A (TBBPA), and hexabromocyclododecanes (HBCDs), were investigated in bivalve (i.e., oyster (Crassostrea gigas) and mussel (Mytilus coruscus)), sediment, and seawater samples collected from aquaculture areas in South Korea to identify their occurrence, sources, and bioaccumulation. Among the studied chemicals, HBCDs predominated in bivalves and sediment, with concentrations of ND-67.52ng/g lipid weight and 3.47-168ng/g dry weight, respectively, while TBBPA was the highest contributor in seawater (ND-2.79ng/L). Compared with a non-aquaculture area, HBCD and PBDE concentrations were significantly higher in all matrices in the aquaculture area (Mann-Whitney U test, p<0.05), suggesting that sources may be located near or associated with the aquaculture areas, such as industrial complexes and expanded polystyrene buoys. Finally, the bioconcentration factor (BCF) and biota-sediment accumulation factor (BSAF) were estimated. Among the studied BFRs, BDE-47 (BCF: 1.70×106L/kg; BSAF: 20.92) and α-HBCD (BCF: 1.05×106L/kg; BSAF: 0.13) showed the highest accumulation potentials in bivalves.

Concentrations of trace metals in tissues of Chionoecetes crabs (Chionoecetes japonicus and Chionoecetes opilio) caught from the East/Japan Sea waters and potential risk assessment.

The concentrations of trace metals (As, Cd, Co, Cu, Fe, Hg, Pb, and Zn) were measured in muscle and hepatopancreas of two Chionoecetes crabs (Chionoecetes japonicus and C. opilio) caught from the East/Japan Sea (EJS) in order to assess the potential health risk by the consumption of deep sea crabs. The highest metal concentrations in muscle and hepatopancreas were As and Fe, respectively, while the lowest metal concentration in two tissues was Pb. The mean concentrations of Cd, Co, Cu, Fe, and Pb in Chionoecetes crabs were one or two orders of magnitude higher in hepatopancreas than in muscles. The mean concentrations of As, Cu, and Hg in muscle and hepatopancreas were relatively higher in C. japonicus than in C. opilio. The estimated daily intakes (EDI) of all metals in muscle were below 0.1% of the provisional tolerable daily intake (PTDI) adopted by the Joint FAO/WHO Expert Committee on Food Additives. Similarly, the target hazard quotient (THQ) of all trace metals in muscle was less than 1.0. These results imply that Chionoecetes crabs caught from EJS do not have an adverse impact on the Korean health. Based on the mean metal concentrations, PTDI, and THQ, the daily maximum permissible intakes of C. japonicus and C. opilio were estimated to be approximately 240 and 410 g/day, respectively.

Human and veterinary pharmaceuticals in the marine environment including fish farms in Korea.

The occurrence trends and effects of 30 human and veterinary pharmaceuticals, including antibiotics, anthelmintics, anti-inflammatory drugs, and ß-blockers, in the marine environment, with a focus on seawater, sediment, cultured fish, and their feed collected from coastal and fish farm areas in the southern sea of Korea, were investigated. The concentrations of total pharmaceuticals in coastal area seawater (mean: 533ng/L) were higher than those in fish farm seawater (mean: 300ng/L), while the opposite trend (coastal area: 136ng/gdrywt

Portable disposable ultrathin endoscopy tested through percutaneous endoscopic gastrostomy.

BACKGROUND: A portable disposable ultrathin endoscope (DUE) with high visual quality and maneuverability would reduce the need for expensive facilities and emergency endoscopy could be available anywhere. It would increase patient satisfaction, prevent unnecessary sedation, and reduce infection. Our aim was to evaluate the usefulness of portable DUE in performing percutaneous endoscopic gastrostomy (PEG). METHODS: We prospectively enrolled patients who underwent PEG under DUE guidance and compared them with historical controls who underwent PEG under conventional ultrathin endoscopy (CUE) guidance. The primary outcomes were successful stomach visualization and PEG tube insertion. RESULTS: Twenty-five patients (19 male) were enrolled and compared with 25 gender and indication-matched controls. The most common indications for PEG were aspiration due to stroke or brain injury, dementia, and head and neck cancer. Entrance into the stomach was achieved in 92.0% (23/25) and 96% (24/25) in the DUE and CUE groups, and PEG was performed in 91.3% (21/23) and 95.8% (23/24), respectively. The mean insertion time for the DUE and CUE groups were 22.7 ±â€Š9.3 minutes and 17.1 ±â€Š5.7 minutes (P = 0.044). The 3 cases of failure to reach the stomach in both groups were caused by esophageal blockage. The 3 cases of failed PEG tube insertion were caused by poor visualization of the insertion site. Bleeding and pneumoperitoneum occurred in 1 and 2 patients in the DUE group. One case of fever was noted in the CUE group. All adverse events were conservatively managed. CONCLUSIONS: Our study shows that portable DUE in facilities without endoscopy equipment may be clinically feasible.

Occurrence, removal and release characteristics of dissolved brominated flame retardants and their potential metabolites in various kinds of wastewater.

The dissolved phase compound and congener specific distribution characteristics of three widely used brominated flame retardants (BFRs) comprising 27 polybrominated diphenyl ethers (PBDEs), 12 hydroxylated and methoxylated metabolites (OH- and MeO-BDEs), 3 hexabromocyclododecanes (HBCDs) and tetrabromobisphenol A (TBBPA) were investigated in influents and effluents of various kinds of wastewater treatment plants (WWTPs), with varying source of wastewater and type of treatment, and nearby rivers in Korea. The concentration of total BFRs were the highest in industrial WWTPs nearby large industrial complexes specialized in heavy chemicals. The distribution of BFRs was differed according to composition of wastewater, with predominance of TBBPA in WWTPs with higher portion of inflowing industrial wastewater. Among HBCD diastereomers, γ-HBCD was dominant in industrial wastewater as consistent to the previous reports, however, similar contribution of α- and γ-HBCD was found in sewage and human wastewater. Through treatment process, PBDEs were the most effectively removed with a mean removal efficiency of 68.3%. HBCDs and TBBPA had removal efficiencies of 41.3% and 48.7%, respectively. The lowest removal efficiency (10.3%) was observed for PBDE metabolites and their concentration in effluent of human wastewater was even increased at maximum 1.9 fold compared with influent, implying the possibility of transformation during treatment. The estimated dissolved phase daily load of PBDEs was highest in sewage while that of TBBPA was highest in industrial wastewater.

Estimating the input of submarine groundwater discharge (SGD) and SGD-derived nutrients in Geoje Bay, Korea using (222)Rn-Si mass balance model.

In order to evaluate the main source of nutrients for maintaining the high production in shellfish farming bay, we have measured (222)Rn activities and the concentrations of nutrients in stream water, seawater, and coastal groundwater around Geoje Bay, one of the largest cultivation areas of oyster in the southern sea of Korea in April 2013. Using the (222)Rn and Si mass balance model, the residence time of bay seawater was about 5days and the submarine groundwater discharge (SGD) into the bay was estimated to be approximately 1.8×10(6)m(3) d(-1). The SGD-derived nutrient fluxes contributed approximately 54% for DIN, 5% for DIP, and 50% for DSi of total nutrient input entering into the bay. Thus, our results suggest that SGD is the major source of nutrients in Geoje Bay, and SGD-derived nutrients are very important to support the biological production of this shellfish farming bay.

A novel occluder for endoscopic closure of gastrotomy: an ex vivo and in vivo animal study.

BACKGROUND AND AIMS: We evaluated the feasibility of a novel occluder for endoscopic closure of natural orifice transluminal endoscopic surgery (NOTES) gastrotomy. METHODS: The occluder is a self-expandable, membrane-covered, metal structure for endoscopic delivery through gastrointestinal (GI) wall defects. The procedure time and air-tightness of endoscopic closure for a 12-mm perforation were compared for a through-the-scope clip group and an occluder group in an ex vivo animal study. The feasibility and safety of the occluder for the closure of NOTES gastrotomy were also evaluated in an in vivo animal study. RESULTS: In the ex vivo study, the median procedure time for closure was significantly shorter and the minimum air-leakage pressure was significantly greater in the occluder group than in the endoclip group. In the in vivo study, immediate air-tight sealing was achieved by application of the occluder and there were no serious adverse events. All animals showed spontaneous detachment of the occluder into the gastric lumen and complete healing within 4 - 8 weeks. CONCLUSIONS: The novel occluder can provide immediate and permanent sealing for NOTES gastrotomy.

Helicobacter pylori infection is not associated with nonalcoholic fatty liver disease.

AIM: To determine whether Helicobacter pylori (H. pylori) infection confers a higher risk of Nonalcoholic fatty liver disease (NAFLD). METHODS: Healthy people who underwent health screening were analyzed retrospectively. Inclusion criteria were age ≥ 20 years, history of H. pylori infection, and recorded insulin level. Participants were classified as H. pylori positive or negative according to (13)C urea breath tests. NAFLD was defined using the hepatic steatosis index (HSI) and NAFLD liver fat score (NAFLD-LFS). Those with an HSI > 36 or NAFLD-LFS > -0.640 were considered to have NAFLD. Multivariable logistic regression was performed to identify risk factors for NAFLD. RESULTS: Three thousand six hundred and sixty-three people were analyzed and 1636 (44.7%) were H. pylori positive. H. pylori infection was associated with older age, male gender, hypertension, higher body mass index, and a dyslipidemic profile. HSI differed significantly between H. pylori positive and negative subjects (median 33.2, interquartile range (IQR) 30.0-36.2 for H. pylori-positive vs median 32.6, IQR 29.8-36.0 for negative participants, P = 0.005), but NAFLD-LSF did not [median -1.7, IQR -2.4 - -0.7 vs median -1.8, IQR -2.4-(-0.7), respectively, P = 0.122]. The percentage of people with NAFLD did not differ between infected and uninfected groups: HIS, 26.9% vs 27.1%, P = 0.173; NAFLD-LFS, 23.5% vs 23.1%, P = 0.778. H. pylori infection was not a risk factor, but C-reactive protein concentration and smoking were significant risk factors for NAFLD. CONCLUSION: H. pylori infection is not a risk factor for NAFLD as indicated by HSI or NAFLD-LFS. Prospective, large-scale studies involving liver biopsies should be considered.

Rapid determination of organochlorine pesticides in fish using selective pressurized liquid extraction and gas chromatography-mass spectrometry.

A rapid automated extraction and cleanup method using selective pressurized liquid extraction was developed and validated for 14 organochlorine pesticides in fish. The lipid-removal efficiencies achieved by adding alumina, Florisil, acid-treated silica gel, and silica gel to the extraction cell were determined and optimized. In the optimized method, fish (2-3g) was placed above alumina (30 g) in the extraction cell, then the sample was extracted using a 7:3 mixture of hexane and dichloromethane. The method was validated using certified reference materials (NIST SRM 1946 and 1974c), spiked fish, and four lipid-rich fish samples. The mean low- and high-concentration spike recoveries were 91% and 93% with RSD<20%, respectively. Measured concentrations of target OCPs showed good agreement with the certified concentrations in certified reference materials. It suggests the good accuracy and precision of the SPLE method. The proposed method met the most important requirements of an extraction and cleanup procedure, including having a short preparation (cleanup and concentration) time and minimal sample contamination and being able to be automated.

Endoscopic Electrosurgery in Patients with Cardiac Implantable Electronic Devices.

BACKGROUND/AIMS: Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients. METHODS: Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram. RESULTS: Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events. CONCLUSIONS: Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed.

Current diagnosis and treatment of benign biliary strictures after living donor liver transplantation.

Despite advances in surgical techniques, benign biliary strictures after living donor liver transplantation (LDLT) remain a significant biliary complication and play an important role in graft and patient survival. Benign biliary strictures after transplantation are classified into anastomotic or non-anastomotic strictures. These two types differ in presentation, outcome, and response to therapy. The leading causes of biliary strictures include impaired blood supply, technical errors during surgery, and biliary anomalies. Because patients usually have non-specific symptoms, a high index of suspicion should be maintained. Magnetic resonance cholangiography has gained widespread acceptance as a reliable noninvasive tool for detecting biliary complications. Endoscopy has played an increasingly prominent role in the diagnosis and treatment of biliary strictures after LDLT. Endoscopic management in LDLT recipients may be more challenging than in deceased donor liver transplantation patients because of the complex nature of the duct-to-duct reconstruction. Repeated aggressive endoscopic treatment with dilation and the placement of multiple plastic stents is considered the first-line treatment for biliary strictures. Percutaneous and surgical treatments are now reserved for patients for whom endoscopic management fails and for those with multiple, inaccessible intrahepatic strictures or Roux-en-Y anastomoses. Recent advances in enteroscopy enable treatment, even in these latter cases. Direct cholangioscopy, another advanced form of endoscopy, allows direct visualization of the inner wall of the biliary tree and is expected to facilitate stenting or stone extraction. Rendezvous techniques can be a good option when the endoscopic approach to the biliary stricture is unfeasible. These developments have resulted in almost all patients being managed by the endoscopic approach.