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Introduction & Objective: EUS-guided biliary drainage (EUS-BD) has been increasingly used for the management of high grade malignant biliary obstruction (HGMBO). Nevertheless, the type of stent that is most suitable for EUS-BD remains controversial. The aim of the present study was to compare operative outcomes between fully covered self-expandable metal stent (FCSEMS) and partially covered self-expandable metal stent (PCSEMS) in HGMBO patients. Methods: The present retrospective cohort study included HGMBO patients who underwent EUS-BD between April 2017 and August 2020. The endpoints were operative outcomes after stent placement. Two-step analysis was performed. Logistic regression was used to calculate a propensity score (PS). Multi-level mixed model stratified by PS were used for comparing the primary and secondary outcomes between groups and are presented in term of adjusted RR, mean difference, hazard ratios and their 95% confidence intervals. Results: There were 53 patients in the study, 41 in the PCSEMS group and 12 in the FCSEMS group. Baseline characteristics were not statistically different. After adjusting for PS, by using the PCSEMS group as the reference, there were no statistically significant differences in the outcomes between PCSEMS and FCSEMS. These include technical success rates (both 100%), clinical success rates (89% vs. 67%; p = 0.489), early and late complications (5% vs 8%; p = 0.493 and 50% vs. 92%; p = 0.110, respectively). Moreover, overall deaths were not significant different (83% vs. 100%; p = 0.971). Conclusion: FCSEMS and PCSEMS in HGMBO were comparable in terms of technical and clinical success. However, PCSEMS patients were less likely to die or have late complications. [ABSTRACT FROM AUTHOR]