Inclusion Criteria:  Age: 18 years and older. Presence of locally advanced or metastatic pancreatic head mass on CT or magnetic resonance imaging of the abdomen Absence of duodenal obstruction. Elevated liver tests with serum bilirubin at least 3 times above the upper limit of normal (1.2 mg/dL). Histologic or cytologic diagnosis of malignancy. Accept sharing in the study.  Exclusion Criteria:  Age younger than 18 years. Pregnancy. Hilar biliary obstruction (as the main lesion or coexisting with distal obstruction). Presence of duodenal obstruction. Histologic or cytologic diagnosis of malignancy. Patients underwent previous intervention for biliary drainage. Previously failed biliary cannulation at ERCP. Prior biliary sphincterotomy or stent placement. Surgically altered anatomy or inability to access the major duodenal papilla. Patients unfit for anesthesia. Patients having uncorrectable coagulopathy or thrombocytopenia. History of allergy to radiocontrast agents. Refuse sharing in the study.