Jaundice/biliary obstruction: ERCP/EUS BD

Biliary obstruction is a common finding in pancreatic cancer due to the close approximation of the biliary tree and pancreatic head. Biliary obstruction can occur due to direct pancreatic head mass effect or secondary to nodal metastasis in case of pancreatic body or tail cancers. Many methods of biliary decompression are available ranging from endoscopic to percutaneous to surgery. Endoscopy is the preferred route of decompression especially through the traditional ERCP but other endoscopic techniques are available these days if ERCP is not successful. Also, percutaneous biliary drainage is an option to consider if endoscopic decompression of malignant biliary obstruction fails or is not feasible. Surgery is not currently a common method due to the associated morbidity and mortality. In this chapter, we will discuss the currently available methods of biliary decompression in the setting of pancreatic cancer.