In settings where metallic stents are rarely available, plastic stents remain widely used for malignant biliary obstruction. This study evaluated real-life technical and clinical outcomes of plastic stent drainage in a Moroccan tertiary center and assessed predictors of early reintervention.

All index ERCPs with plastic stent placement for malignant biliary strictures (2017–2023) were retrospectively reviewed. Technical success was defined as successful cannulation and stent deployment across the stricture with adequate drainage. Clinical success at one month required symptomatic improvement and ≥50% bilirubin reduction when available. Data included demographics, stricture level, papillary anatomy, and prior drainage. Outcomes were technical/clinical success, early ERCP-related adverse events, and need for repeat ERCP due to stent dysfunction. Logistic regression explored predictors of reintervention.

A total of 510 patients were analyzed (mean age 66 ± 13 years; 51% male). Technical success reached 99%, with effective drainage in nearly all cases. Clinical success at one month was 80%, consistent with ESGE benchmarks. Early adverse events occurred in 8%, mainly mild pancreatitis (5%) and limited post-sphincterotomy bleeding (2%); perforations were rare (<1%). Repeat ERCP was required in 11%, predominantly due to stent occlusion or migration. No independent predictors of early reintervention were identified

In the absence of metallic stents, plastic stents achieve excellent technical success, reliable early clinical improvement, and an acceptable safety profile in malignant biliary obstruction. These real-life results highlight that high-quality biliary drainage can be delivered in resource-limited centers while aligning with ESGE quality indicators. Plastic stents remain a pragmatic, cost-effective solution when SEMS availability is restricted.