Treatment of malignant and benign biliary obstructions with metal stents

The palliative treatment of malignant bilary tract obstructions using a met al stent is now an established procedure in clinical practice, An endoscopi c, transpapillary approach is the first choice for implantation of the sten t. If it is not possible to insert the stent in this way, which is often th e case with high obstructions, a percutaneous approach is chosen. It appear s to be beneficial to use a metal stent with a fine-meshed net such as, for example, the Wall stent. Metal stents have a higher patency rate than plas tic stents so that the primary choice of a metal stent is justified, Coated stents have not yet shown any major advantages. In cases of stent occlusio n, the coaxial implantation of a plastic stent seems to be the most efficie nt. In cases of benign biliary tract stenoses, a metal stent should only be implanted after a careful evaluation of all possible surgical modalities a nd exploitation of balloon dilatation and long-term splinting methods.