Self-expanding metal stents outperformed plastic stents in patients with malignant hilar biliary obstruction, crucial for decision-making in palliative care.

• SEMs had a clinical success rate of 76.9% versus 51.1% for PS (p=0.015).
• Patency was significantly longer for SEMs (median 213 days) compared to PS (78 days; p=0.01).

Choose SEMs for longer-lasting drainage but note overall survival rates remain similar between types.

• Clinical success is linked to ECOG status (0-2) and bilirubin <10 mg/dl, not stent type alone.