Over the past decades, endoscopic retrograde cholangiopancreatography (ERCP) has proven to be the gold standard approach as a therapeutic device for biliary obstruction in both benign and malignant stricture. Since ERCP is not always successful and has failed in multiple occasions another salvage therapy was developed and recently endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) has been showing remarkable results in these settings. The current prospective study aims to assess the impact of types of the stents used in EUS-HGS in patients with malignant biliary obstruction on the short-term outcomes. Methods: This study was a randomized controlled study carried out at Mansoura Specialized hospital. Patients with distal malignant biliary obstruction undergoing EUS-HGS were randomized into two groups. Group A underwent plastic stent insertion, Group B underwent metallic stent insertion namely the half to half stent. The primary outcomes included rate of complications of EUS-HGS between the two groups (metallic versus plastic stents) while the secondary outcomes included success rates and stent patency. Results: We enrolled 14 patients in our study. These patients were randomized into two groups. 7 patients had metallic stent and 7 patients had plastic stent. No statistically significant difference was detected regarding success or complications between the two groups. Conclusions: Both metallic and plastic stents are suitable options for patients with distal malignant biliary obstruction in EUS-HGS with similar success rates and safety profile.