NICE guideline 7: Relieving a bile duct or duodenum blocked by pancreatic cancer

Blocked bile duct (biliary obstruction)

Pancreatic cancer can block the bile duct, causing jaundice.

7.1 If your cancer can be removed with surgery and you have jaundice, you should be offered surgery rather than having a stent inserted first to treat the jaundice – if you are well enough and aren’t on a clinical trial that requires a stent.

7.2 If a surgeon starts surgery to remove the cancer but finds it’s not possible to remove it, they should carry out bypass surgery to treat the blocked bile duct.

7.3 If you have jaundice and can have surgery to remove the cancer but you aren’t yet fit enough for the operation, you should be offered a metal stent to treat the jaundice. This should be inserted using ERCP.

7.4 If you have suspected pancreatic cancer and are having a stent inserted to treat the jaundice which may need to be removed later on, doctors should consider using a covered metal stent, inserted using ERCP.

A covered metal stent is a tube made of wire mesh, with a covering around the outside of it. Covered metal stents are easier to remove.

7.5 If you have jaundice and your cancer can’t be removed with surgery, you should be offered a metal stent to treat the jaundice, rather than bypass surgery.

Blocked duodenum (duodenal obstruction)

Pancreatic cancer can block the duodenum (first part of the small intestines), causing sickness.

7.6 If a surgeon starts surgery to remove pancreatic cancer but finds that it’s not possible to remove it, they should consider surgery to stop the cancer from growing to block the duodenum in the future.

7.7 If you have pancreatic cancer that can’t be removed with surgery and have a blocked duodenum which is causing symptoms, the blockage should be relieved if possible.

7.8 If you have a blocked duodenum, your doctor should consider bypass surgery rather than a duodenal stent if you are likely to live longer.

This is because the evidence suggests that a stent may be more effective in the short term, and bypass surgery may be more effective in the longer term.

Published: August 2018

Review date: August 2023