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In those who are candidates for surgery, preoperative biliary drainage (PBD) has been developed since the 1960s in order to improve surgical outcomes. While obstructive jaundice in resectable pancreatic cancer has been traditionally treated before surgical resection in all patients, data over the past decade demonstrated increased perioperative complications and morbidity with systematic PBD compared to direct surgery. With new evidence of potential adverse events, the role of routine PBD is being reassessed. Current indications for PBD include cholangitis, delayed surgery, and relief of jaundice in patients planned to receive neoadjuvant therapy (NAT). NAT is being increasingly utilized in borderline resectable as well as resectable pancreatic cancer and a higher proportion of patients with likely require PBD in the future. The evidence for endoscopic retrograde cholangiopancreatography as first line for PBD is robust with supporting data from endoscopic ultrasound assisted biliary drainage. Self\u2010expanding metal stent was shown to be cost\u2010effective in recent studies without increase in morbidity compared to plastic stents in this setting. In this review, we will summarize the current evidence for PBD in patients with pancreatic cancer.<\/jats:p>","DOI":"10.1111\/den.14081","type":"journal-article","created":{"date-parts":[[2021,7,18]],"date-time":"2021-07-18T13:39:20Z","timestamp":1626615560000},"page":"428-438","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Preoperative biliary drainage for pancreatic cancer"],"prefix":"10.1111","volume":"34","author":[{"given":"Fredy","family":"Nehme","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Nutrition The University of Texas MD Anderson Cancer Center Houston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Nutrition The University of Texas MD Anderson Cancer Center Houston 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