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This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.Endoscopic biliary stenting is the most widely accepted procedure for the management of symptomatic biliary obstruction. In cases of unresectable malignant distal biliary obstruction (UMDBO), stent placement plays a key role in maintaining biliary flow and in improving prognosis and quality of life. Self-expandable metallic stents (SEMSs) have been used widely in patients with UMDBO because SEMSs give rise to longer