Nonoperative methods for decompressing the biliary tree obstructed by tumor offer viable alternatives to the use of surgery alone to palliate jaundice, pruritus, and impending cholangitis. Published data indicate that biliary drainage through endoscopic means may be superior to the percutaneous route, both being superior to surgical palliation in patients with unresectable pancreatic adenocarcinoma. We have inserted endoprostheses in 277 patients with carcinoma of the pancreas with a success rate of 89%. Eighteen percent of the patients were deceased in 30 days, however, there was no procedure related surgery or death. These results were achieved with a complication rate of only 21% (major = 4%). The occlusion rate was found to be 30% in 3 months. Patients were hospitalized for a mean of 3.5 days with a mean survival of 129 days. The advantages of endoscopic biliary drainage are as follows: low procedure related mortality, low incidence of major complications, and short hospital stay. In conclusion, given the short mean survival of patients with unresectable malignant biliary obstruction, nonsurgical decompression should be considered as primary treatment.