Pre-operative Biliary SEMS RCT During Neoadjuvant Therapy

Inclusion Criteria: * Age 18 or older * Patient indicated for biliary metal stent placement for the treatment of jaundice and/or cholestasis * Willing and able to comply with the study procedures and provide written informed consent to participate in the study * Suspicion of pancreatic adenocarcinoma * Likely indicated for neoadjuvant treatment * Distal biliary obstruction consistent with pancreatic cancer * Location of distal biliary obstruction such that it would allow the proximal end of a stent to be positioned at least 2 cm from the hilum * Endoscopic and surgical treatment to be provided at the same institution Exclusion Criteria: * Benign biliary strictures * Malignancy secondary to Intraductal Papillary Mucinous Neoplasm * Surgically altered anatomy where ERCP is not possible * Previous biliary drainage using a SEMS or multiple plastic stents * Contraindications for endoscopic techniques * Patients who are currently enrolled in another investigational trial that would directly interfere with the current study * Pregnancy