Age 18 or older

Patient indicated for biliary metal stent placement for the treatment of jaundice and/or cholestasis

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

Suspicion of pancreatic adenocarcinoma

Likely indicated for neoadjuvant treatment

Distal biliary obstruction consistent with pancreatic cancer

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

Endoscopic and surgical treatment to be provided at the same institution

Pre-operative Biliary SEMS RCT During Neoadjuvant Therapy