Once the lesion is visualized endoscopically, a 5 Fr catheter threaded with a hydrophilic guidewire is passed via the endoscope’s 3.7mm working channel beyond the lesion. Threading is further facilitated via radiological guidance using static X-rays or uoroscopy (Fig. 27.1) [34]. Angulated strictures may require initial traversal either with a J-wire or with the use of a sphincterotome as cannula. The guidewire is retrieved, and water-soluble contrast is injected through the catheter to delineate the lesion and conrm required stent length under radiological guidance, if this is not clear by just observation of air contrast. A super stiff guidewire replaces the hydrophilic one (Fig.27.2), the catheter is removed, and the compressed SEMS delivery system is passed over the guide­wire into position (Fig.27.3) and expanded under both uoroscopic and endo­scopic visualization (Fig.27.4). Patency is conrmed by water-soluble contrast which also ensures the absence of leaks. Additional dilation via balloon is not performed to avoid perforation. X-rays are taken the day of the procedure and the day after to conrm appropriate placement, non-migration, and rule out asymp­tomatic perforation.