Objective To investigate the value, safety and efficacy of fully-covered self-expandable metallic stent (FCSEMS) in endoscopic retrograde cholangiopancreatography (ERCP) procedures for pancreatic-biliary diseases. Methods The clinical data of 56 patients with pancreatic-biliary diseases, who underwent FCSEMS treatment via ERCP from January 2008 to June 2012, were retrospectively analyzed. The stents of different lengths and types were chosen according to the condition of patients. The stents were removed under endoscope. The therapeutic effects at end point, stent removing rate and associated complications were observed. Results FCSEMS was placed in 49 patients with benign stricture, including post-liver transplant stricture (32), iatrogenic biliary stricture (12) and chronic pancreatitis-associated stricture (5). The mean follow time was (15±8.6) months (range 5-38 months), the mean stent duration was (8.4±5.3) months (1-15 months), and the effective rate was 89.8% (44/49). FCSEMS was placed in 7 patients with biliary complications, including bleeding after endoscopic sphincterotomy (EST) (4), perforation after EST (1), and bile leakage following liver transplantation (2). The mean follow time was (5±3.7) months (range 1-12 months), the mean stent duration was (1.8±0.5) months (1-8 months), and the effective rate was 100%. All FCSEMS were successfully retrieved. The short-term complication rate associated with stent was 8.9% (5/56), including post-ERCP pancreatitis (2), early cholangitis (2) and cholecystitis (1). The long-term complication rate was 12.5% (7/56), including stent slip (2), stent translocation (3) and stent-associated cholangitis (2). Conclusion FCSEMS can not only be used to treat traditional benign pancreatic-biliary strictures, but alto serve as a potential substitute for safe and effective treatment of serious biliary complications.