AIM: To describe a simple one-step method involvingpercutaneous transhepatic insertion of an expandablemetal stent (EMS) used in the treatment of obstructivejaundice caused by unresectable malignancies.METHODS: Fourteen patients diagnosed withobstructive jaundice due to unresectable malignancieswere included in the study. The malignancies in thesepatients were a result of very advanced carcinoma orold age. Percutaneous transhepatic cholangiographywas performed under ultrasonographic guidance. After acatheter with an inner metallic guide was advanced intothe duodenum, an EMS was placed in the common bileduct, between a point 1 cm beyond the papilla of Vaterand the entrance to the hepatic hilum. In cases where itwas difficult to span the distance using just a single EMS,an additional stent was positioned. A drainage catheterwas left in place to act as a hemostat. The catheter wasremoved after resolution of cholestasis and stent patencywas confirmed 2 or 3 d post-procedure.RESULTS: One-step insertion of the EMS was achievedin all patients with a procedure mean time of 24.4 min.Out of the patients who required 2 EMS, 4 needed aprocedure time exceeding 30 min. The mean time forremoval of the catheter post-procedure was 2.3 d. Allpatients died of malignancy with a mean follow-uptime of 7.8 mo. No stent-related complication or stentobstruction was encountered.CONCLUSIONS: One-step percutaneous transhepaticinsertion of EMS is a simple procedure for resolvingbiliary obstruction and can effectively improve thepatients quality of life.