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