The placement of a percutaneous expandable biliary endoprosthesis was first reported in 1985 by Carrasco et al. in a canine model, and the endoscopic placement of expandable metal stents to relieve biliary strictures in patients was first described in 1989.[2,3] Over the past two decades, the endoscopic approach to biliary endoprosthesis placement has largely supplanted the percutaneous approach. Self-expanding metal stents (SEMS) have traditionally been used for palliation of obstructive jaundice in patients with unresectable pancreaticobiliary tumors. However, SEMS are increasingly being used in patients with resectable cancers and benign biliary strictures. Uncovered SEMS (uSEMS) have been shown to have longer patency periods than plastic stents when used for malignant biliary obstruction and to be cost effective if the patient's life expectancy is greater than 4–6 months.[6–8] The common causes of malignant biliary obstruction are pancreatic cancer and cholangiocarcinoma.[9–11] Biliary drainage prior to surgical resection is controversial; several investigators have reported it to be beneficial owing to the improved tissue healing with reduced bilirubin levels,[12,13] but others have also reported its deleterious effects secondary to the additional intervention..