الفهرس 
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Abstract
Aim of the work
Purpose of this study is to determine whether surgical bypass or endoscopic metallic stenting is better regarding hospital stay, cost, morbidity and mortality.
Summary and conclusion
The majority of patients with pancreatic cancer have evidence of locally advanced or metastatic disease at time of diagnosis. The care of these patients should focus on improving the patients’ QOL.
Palliation of biliary obstruction can be accomplished with surgical or endoscopic techniques. Although both are technically successful drainage options, endoscopic stenting of the bile duct has been shown to significantly reduce the length of hospitalization and is associated with lower procedure related morbidity and mortality.
Two types of biliary stents can be used, plastic and metallic stents. Plastic biliary stents have a tendency to clog and may require repeated endoscopic interventions. In addition, use of metal stents has been shown to be a cost-effective strategy in patients who are expected to survive longer than 6 months.
Surgical bypass for advanced pancreatic cancer can be considered as an appropriate procedure in patients discovered at time of surgery:
*Unresectable cancer discovered at time of surgery.
*Gastric outlet obstruction.
*Life expectancy of at least 6 months.