Biliary stents and endoprostheses may be used for the treatment of both benign and malignant disease. Stents are commonly placed endoscop-ically, but they may be placed by the interventional radiologist by percutaneous methods or at the time or surgery. Stents are generally placed to provide biliary drainage in patients with both benign and malignant obstruction, tone disease, or cholangitis, to treat cystic duct leaks after cholecystectomy, and to protect surgically created anastomoses. For the long-term treatment of biliary obstruction, removable endoprostheses may be made of plastic, whereas metal stents are permanent. The most common indication for stent placement in malignant disease is pancreatic cancer, although central cholangiocarcinoma and metastatic disease may be amenable to treatment with multiple stents (Fig. 4.44).
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