Background: Uncovered metal biliary stents have superior patency rates compared to plastic stents in the palliation of malignant biliary strictures. The rate of tumor ingrowth may be decreased by the use of a covered metal stent. This report describes a multicentre experience with a new covered Wallstent(Microvasive, Natick, USA)in 33 patients with malignant bile duct obstruction. The new design incorporates a silicone coating. This study was sponsored by Microvasive Endoscopy, Boston Scientific Corporation. Patients and Methods: 33 patients, 17 male, mean age 68 yr,(32 - 92)were included in the study. 21 (64%)patients had pancreatic carcinoma, 5 (15%) gastric carcinoma (3 BII gastrectomy), 3 (9%) cholangiocarcinoma, 1 (3%) ampullary carcinoma, 1 (3%) hepatoma,1 (3%) metastatic breast carcinoma and 1 unconfirmed. 25 (76%) had prior stent placement(1 metal). The length of obstruction ranged from 10 to 54 mm (mean 27 mm). Covered stents were placed in 8 pts transhepatically (San Francisco, Miami), in the remaining 25 pts endoscopic placement under fluoroscopic control (Toronto, Calgary). Results: Stent deployment was satisfactory in 31 out of 33 cases. Stent positioning was not optimal in 2 pts (1 transhepatic, 1 endoscopic) requiring immediate placement of additional uncovered Wallstents. Radial expansion ranged from 25 to 100%. Mean bilirubin level decreased from 150 μmol/L to 24 μmol/L at 1 month. Early complications included minor pain in 2 pts and acute cholecystitis in 1 pt requiring cholecystectomy. At 6 months, 15 pts had died, none with stent related complications. Among the 16 living pts, 3 developed obstructive jaundice (3-6 mos), 2 due to partial migration and one due to sludge. Overall 6 month complication rate was 19% (6/31). Conclusions:The new covered Wallstent remained patent until death or at 6 mos follow up in 28/31 pts. There was no evidence of ingrowth or overgrowth and in 2 cases obstruction at the proximal end of the stent could be attributed to partial migration. The design of this covered stent offers the potential of prolonged patency.