Endoscopic palliation of malignant biliary obstruction due to pancreatic cancer has become an accepted alternative to surgical bilioenteric bypass over the last decade. Clinical experience and randomized trials have shown equal efficacy with lower initial morbidity and mortality rates for endoscopic biliary stent therapy but the problem of stent occlusion remains as the dominant late problem. Metallic stents have an improved patency rate and are cost-effective. Newer applications of endoscopically-placed stents for pancreatic pain and gastric outlet obstruction are being explored. The place of laparoscopic approaches to the consequences of pancreatic cancer has yet to be defined.