Summary Background: Biliary stent clogging is the principal limitation in the use of palliative treatments for malignant biliary stricture. The patency of metal stents lasts longer than that of plastic stents but metal stents are more expensive. Well-established criteria for choosing metal or plastic stents do not yet exist Patients and Methods: A retrospective trial was carried out with 80 patients in Pablo Tobon Hospital, between January 2002 and June 2008. 40 patients had plastic stents implanted while the other 40 had metal stents installed. Biliary stricture improvement, stricture recurrence, complications and survival rates for each group were compared. Results: 48 males (60%) and 32 females (40%) with an overall average age of 66±6 years and ages ranging from 47 years old to 78 years old were diagnosed with inoperable malignant distal biliary stricture. The two groups were comparable in terms of ages, genders, laboratory tests, diagnoses and liver metastases. Clinical success was the same for both treatments (92%). Hospital stays were signifi cantly shorter for patients with metal stents than for patients with plastic stents. (6.1 ± 6.6 days versus 10.6 ± 5.9 days. 95% confi dence interval: 1.6 to 7.2, p<0.01). Recurrent biliary stricture was identifi ed in 19 of 40 patients with plastic stents (47.5%) and 13 of 40 patients with metal stents (45%) (95% Confi dence Interval: -0.4 to 0.08, p=0.2). Average duration of stent patency was longer in patients with metal stents than in patients with plastic stents (174.2 ± 60.4 days versus 108 ± 50.9 days. 95% confi dence interval: 41.1 to 90.8, p<0.01). Early complications occurred in 5% of patients with metal stents and in 12.5% of patients with plastic stents (95% confi dence interval: -0.22 to 0.07, p = 0.4). Later complications occurred in 42.5% of patients with plastic stents and 30% of patients with metal stents (95% confi dence interval: -0.35 to 0.1, p = 0.3). Patients with metal stents required less intervention for treatment of complications than did patients with plastic stents (6 versus 17. 95% confi dence interval: 0.06 to 0.48, p<0.01). Patients with metal stents required endoscopic retrograde cholangiography (ECRP) 11 times, whereas patients with plastic stents required ECRP 18 times (95% Confi dence Interval -0.4 to 0.05, p=0.1). Average survival time after stent insertion was 159.4 ± 9.4 days for plastic stents and 189.5 ± 7.6 days for metal stents (p=0,07). Conclusions: Plastic and metal stents are effective for inoperable distal malignant stricture treatment. However a comparison between the two types of stents reveals that although patient survival rates for the two types of stents are equal, metal stents had better patency, and patients with metal stents had shorter hospital stays, and fewer procedures for complications.