Biliary stenting: cosmetic or clinical value?

Since the initial description of endoscopic placement of transpapillary stents, this technique has gained wide acceptance in the management of pancreatico-biliary diseases. We now know by and large what can be achieved and what the complications are. Studies comparing endoscopic and surgical treatment in pancreatic cancer patients show an initial advantage of the endoscopic method, which is partly counterbalanced by the late complications of stent blockage. Clinical studies are necessary to define better the subgroups of patients that benefit most from the various treatment modalities. Further improvement is necessary to solve the problem of late stent occlusion.