Jang S, Stevens T, Parsi MA, et al. - In this cohort study of patients who underwent endoscopic retrograde cholangiopancreatography with stent placement for the treatment of malignant biliary stricture, researchers performed a comparison between plastic stents (PS) and self-expandable metallic stents (SEMS) in terms of effectiveness and adverse outcomes. There were 1,139 patients who underwent endoscopic retrograde cholangiopancreatography with PS placement and 1,008 patients who received SEMS for the management of malignant biliary stricture between 2012 and 2019. A significantly higher rate of clinical success and a lower rate of unplanned reintervention in distal strictures was achieved with SEMS vs PS. With SEMS vs PS, a significantly longer patency duration and time to unplanned reintervention were reported, regardless of stricture location. Given superior efficacy, durability as well as lower rates of cholangitis, experts recommend SEMS as the first line endoscopic management choice for malignant distal biliary stricture. Moreover, it affords an attractive alternative to PS in some cases for managing malignant hilar stricture because of providing a similar efficacy with superior durability.