Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs) have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following endoscopic sphincterotomy (ES), and postsphincterotomy bleeding. Despite the higher costs of these devices, fully covered self-expanding metal stents seem to be a suitable therapeutic option to relief biliary obstruction due to bile duct stenosis, regardless of the underlying cause. 1. Introduction A multicenter trial comparing preoperative biliary drainage to early surgery for cancer of the pancreatic head showed that routine preoperative biliary drainage increased the rate of complications significantly [1]. The authors concluded that it should not be used routinely. Although drainage was primarily successful in 94%, there was a significant rate of cholangitis and a rate of 30% for the need of stent exchange leading to more readmissions. In addition, surgeons often report that they feel that anastomosis of the remaining biliary tract to the jejunal loop is more difficult and hampered because of the local inflammation caused by the stent. Nevertheless, in the trial above, plastic stents have been used. These stents have a narrow diameter which results in a high rate of stent occlusion over time with consequent cholangitis. This problem can partially be overcome using wide-bore stents such as self-expanding metal stents [2]. The disadvantage of these devices, however, is that once positioned they cannot be removed effortlessly without major damage to the biliary duct. Recently, completely covered self-expanding metal stents (CSEMSs) have become available making removal either endoscopically or during surgery easily possible. Accordingly, fully covered self-expandable metal stents have been lately used for the management of various malignant as well as benign biliary disorders, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, and postsphincterotomy bleeding. Recent data demonstrated that biliary drainage can be achieved using fully covered self-expanding metal stents regardless of the underlying disease, be it benign or malignant. These stents were not associated with a higher rate of complication compared to
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