Toward a “dream” stent for malignant biliary obstruction: one that allows patients—and endoscopists—to sleep soundly at night

Endoscopic decompression for distal malignant biliary obstruction (DMBO) remains a cornerstone of care to relieve jaundice, facilitate systemic therapy, and reduce infectious adverse events.1 Although studies have demonstrated that fully covered self-expandable metal stents (FCSEMSs) with antimigration mechanisms can prevent stent migration in benign biliary strictures,2 their efficacy for relieving DMBO remains unclear.3,4 FCSEMSs may provide longer patency and require fewer unplanned exchanges than plastic stents; however, stent migration remains a significant issue, compromising clinical durability and potentially causing recurrent biliary obstruction (RBO), repeat procedures, and interruptions in oncologic treatment.