Inclusion Criteria:

- 20 years of age or older

- oral and written information given and informed consent obtained

- clinical data in accordance with malignant bile duct obstruction

- ultrasonography signs of extrahepatic malignant common bile duct obstruction

- typical radiological findings at ERCP of malignant common bile duct stenosis

- proximal margin of the bile duct stenosis at least 2 cm from the hepatic confluence

- bilirubin > 50 micromol/L

- radical surgery estimated not possible (temporary stenting with insertion of a
plastic stent can be obtained but should be replaced by a metal stent within 4 weeks
after the first ERCP procedure, and the patient is randomized at the time of
insertion of the metal stent)

Exclusion Criteria:

- patients with active hepatitis or other hepatic diseases that may cause jaundice

- informed consent not obtained

- metastasis with numerous significant intrahepatic stenosis causing blockage of one or
more segments of the liver (if no segment blockage, liver metastasis is not an
exclusion criteria)

- the patient is probably a candidate for surgical resection

- suspicion of a non-malignant bile duct obstruction, e.g. stones or benign stenosis
(should initiate further investigations)

- the proximal end of the stenosis is located within 2 cm from the hepatic confluence

- the patient has previously undergone BII or Roux-en-Y gastric resection, or has a
significant duodenal obstruction making ERCP difficult

- previously (more than 4 weeks earlier) treated with a bile duct stent

- severe coagulation disturbance (PK-INR > 1.6)