Purpose: Endoscopic papillectomy is an effective approach for ampullary adenomas. To date, all prior studies have used plastic biliary stents after papillectomy. The efficacy of covered self-expanding metal stents (CSEMS) to maintain biliary drainage and provide improved visualization of the distal bile duct (after stent removal), has not been studied. Our aim was to evaluate the use of CSEMS in the setting of endoscopic papillectomy for ampullary adenomas. Methods: Between May 2004 to June 2009, 134 patients were referred for the management of ampullary lesions. Those patients who had endoscopic papillectomy with CSEMS deployment were selected. Procedures included ERCP with double sphincterotomy, saline lifting assisted snare resection, prophylactic pancreatic duct stenting and temporary placement of covered Wallstent (Boston Scientific) or Viabil (Conmed) as well as Argon Plasma Coagulation (APC) of any residual neoplastic tissue. Repeat sessions included CSEMS removal and further resection. Number of follow up sessions for treatment, adenoma recurrence, stent patency, and associated complications were collected retrospectively. Results: Thirty-one patients (55% men, mean age 68±28 years) received CSEMS. All patients had an initial diagnosis of ampullary adenoma with a mean size of 2.3 cm (range 0.5-4 cm). 5 patients with high grade dysplasia or cancer were referred for surgery. 5 patients were lost to follow up after subsequent ERCP to remove CSEMS. A total of 21 patients had repeat sessions with resection of ampullary adenoma with placement of CSEMS. A mean of 2.3 procedures (range 1-5) were required for complete ablation. At the end of follow-up, 17/21 (80%) patients had no residual adenomatous tissue with a mean of 2.6 procedures for surveillance after ablation (range 1-10). Complications included: post papillectomy bleeding amenable to hemostasis with clipping (n=4), post ERCP pancreatitis (n=1) and CSEMS migration requiring stent revision (n=1). No subsequent strictures, extension of residual lesions inside of bile duct, or evidence of biliary obstruction were observed after initial papillectomy and deployment of CSEMS. Conclusion: This is the first study to evaluate the use of CSEMS along with endoscopic papillectomy. Our results demonstrate the use of CSEMS to be effective in preventing biliary complications. The ability to examine the bile duct due to improved visualization of the duct allows for better assessment of intraductal involvement. The use of CSEMS may prove to be advantageous over plastic stenting however a randomized controlled trial comparing the two is suggested. Disclosure: Dr Michel Kahaleh - Consultant, Research support, Boston Scientifi c; Research support, ConMed; Research Support, Alimaxx; Research support, Wilson Cook.