Questions about stents or bypass surgery?
If you have questions about a blocked bile duct or duodenum and how these are managed, speak to your doctor or nurse.
You can also speak to our specialist nurses on our free Support Line.
Read all the NICE guidelines for pancreatic cancer
- Explaining the NICE guidelines for diagnosing and managing pancreatic cancer
- NICE guideline 1: Diagnosing pancreatic cancer
- NICE guideline 2: Specialist pancreatic multidisciplinary teams
- NICE guideline 3: Working out how far pancreatic cancer has spread (staging)
- NICE guideline 4: Emotional (psychological) support
- NICE guideline 5: Managing pain
- NICE guideline 6: Managing diet and nutrition
- NICE guideline 7: Relieving a blocked bile duct or duodenum
- NICE guideline 8: Managing resectable (operable) and borderline resectable pancreatic cancer
- NICE guideline 9: Managing pancreatic cancer that can’t be removed with surgery (inoperable or unresectable cancer)
Blocked bile duct (biliary obstruction)
Pancreatic cancer can block the bile duct, causing jaundice. A stent is a tube that can be put into the bile duct to open the blockage.
7.1 If you can have surgery, you should be offered surgery rather than a having stent put in first to treat the jaundice if:
- you are well enough for the operation
- you are not on a clinical trial that means you need a stent.
Read more about when stents are used.
7.2 Sometimes a surgeon starts surgery to remove the cancer but finds it’s not possible to remove it. If this happens, they should do bypass surgery to treat the blocked bile duct.
Read about bypass surgery.
7.3 You should be offered a metal stent to treat jaundice if surgery to remove the cancer is possible, but you aren’t yet fit enough for the operation.
The stent should be put in using ERCP.
7.4 If you have suspected pancreatic cancer and are having a stent put in which may need to be removed later, doctors should consider using a covered metal stent. This is put in using ERCP.
Sometimes, if it turns out the person does not have pancreatic cancer, the stent may need to be removed. 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 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 intestine), causing sickness.
7.6 Sometimes the surgeon starts surgery to remove pancreatic cancer but finds that it’s not possible to remove it. If this happens they should consider surgery to stop the cancer from growing to block the duodenum in the future.
This is called bypass surgery.
7.7 Doctors should try to relieve a blocked duodenum if it is causing symptoms and you can’t have surgery.
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.
Read more about stents and bypass surgery to treat a blocked bile duct or blocked duodenum.
Speak to our nurses
Published: April 2025
Review date: April 2028