Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement remains the cornerstone of palliation for patients with malignant distal biliary obstruction (MDBO). The choice between plastic stents (PS) and self-expanding metallic stents (SEMS) continues to ignite debate due to their varying patency duration, complication rates and cost effectiveness. While PS are less expensive and suitable for short term drainage, SEMS are favored for longer term management owing to their wider diameter and reduced occlusion rates. Nevertheless, clinical decisions are often influenced by patient survival, local resources, and anticipated need for reintervention. This study was conducted at King Hamad Univerity Hospital, a tertiary care center in Bahrain to compare outcomes of PS versus SEMS in patients with MDBO.

A retrospective cohort study was conducted at King Hamad University Hospital between January 2019 and May 2024. Demographic data, comorbidities, malignancy type, biochemical parameters, and post ERCP complications were reviewed. Comparative analyses between PS and SEMS groups were performed using appropriate statistical tests. Primary outcomes included improvement in bilirubin levels and liver enzymes post ERCP. Secondary outcomes assessed adverse events, reintervention and readmission rates. 

A total of 54 patients with MDBO underwent ERCP with stenting for palliation (24 metallic, 30 plastic). Both groups demonstrated significant reductions in total and direct bilirubin, AST, and ALT following ERCP (p < 0.001). There were no statistically significant differences in cholangitis, migration or readmission rates. Reintervention was less frequent among PS recipients (58% vs. 43%), though not statistically significant. Addtionally, time to reintervntion was longer with patients who received SEMS compared to PS. Overall, both stent types achieved comparable biochemical improvement and palliation.

In this retrospective study, both PS and SEMS provided effective biliary drainage and comparable biochemical improvement in patients with MDBO. Complications and readmission rates were similar, while SEMS demonstrated a longer time to reintervention. Overall, either stent type can be used effectively and stent selection should remain individualized based on prognosis, cost, and institutional resources.