Metal stents for malignant biliary obstruction

The main problem in the palliative treatment of malignant biliary obstruction is recurrent jaundice and cholangitis due to clogging of the endoprostheses. Large-bore metal stents, which can be placed using small-sized delivery systems, have been recognized as an important gain. Their use has facilitated the percutaneous drainage procedure. The long-term patency rates of both endoscopically and percutaneously placed metal stents seem to be better than those of conventional stents. Although the long-term economical aspects are in favor of metal stents due ot the decreased need for readmissions and reinterventions, the high initial costs of metal stents constitute the main obstacle to their wide-spread use.