Preoperative Biliary Drainage in Resectable Pancreatic or Periampullary Cancer

Inclusion Criteria:

   - Age 18 or older

   - Willing and able to comply with the study procedures and provide written informed
   consent to participate in the study

   - Diagnosis of probable pancreatic cancer, distal common bile duct (CBD)
   cholangiocarcinoma and other periampullary cancers (histology not required)

   - Biliary obstructive symptoms or signs

   - Bilirubin level at/above 100 umol per liter (5.8 mg/dL)

   - Distal biliary obstruction consistent with pancreatic cancer, distal CBD
   cholangiocarcinoma or other periampullary malignancy

   - Location of distal biliary obstruction is such that it would allow the proximal end of
   a stent to be positioned at least 2cm from the hilum

   - Patients deemed as resectable by pancreatic protocol CT or MRI

   - Surgical candidate per pancreatobiliary surgeon after multi-disciplinary discussion

   - Surgery intent within 4 weeks

   - Endoscopic and surgical treatment to be provided by same team

Exclusion Criteria:

   - Biliary strictures caused by confirmed benign tumors

   - Biliary strictures caused by malignancies other than pancreatic cancer, distal CBD
   cholangiocarcinoma and other periampullary cancers

   - Surgically altered biliary tract anatomy, not including prior cholecystectomy

   - Neoadjuvant chemotherapy for current malignancy

   - Palliative indication due to reasons other than surgical candidate status

   - Previous biliary drainage by ERCP/PTC

   - Patients for whom endoscopic techniques are contraindicated

   - Participation in another investigational trial within 90 days

   - Pregnancy