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Initially described by Soehendra and Reynders-Frederix1 in 1980, plastic stents have been widely used for endoscopic relief of malignant biliary obstruction. The relative ease of placement and removal of plastic stents, as well as their low cost, have made them an attractive option for the past 35 years. It has been apparent for decades, however, that self-expandable metal stents (SEMS) provide much more durable biliary drainage than plastic stents. Accumulating evidence now suggests that it may no longer be justifiable to use plastic stents when it is clear that metal stents are associated with superior outcomes, fewer adverse events (AEs) and fewer repeated interventions.2 These advantages, along with reductions in length of hospital stay, appear to fully offset the high initial cost of selecting an SEMS over a plastic stent for palliation of malignant distal biliary obstruction—even in patients whose projected life expectancy is limited.3 ,4 In patients with borderline resectable pancreatic cancer who are undergoing neoadjuvant therapy, SEMS have also …
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