Chan ACY, et al. – This work was planned to assess the difference in treatment efficacy of endoscopic self–expendable metal stent (SEMS) and surgical bypass (SB) in the management of malignant biliary obstruction (MBO) secondary to pancreatic cancer. In spite of being more invasive and expensive, surgical bypass seemed to provide durable relief of biliary obstruction. Endoscopic SEMS was associated with minimal procedural risks and low re–intervention rate, this made it a considerable procedure for frail patients with limited life expectancy.