Pancreatic cancer has long been associated with profound morbidity and mortality, much of which stems from its anatomic location and the resultant complications such as biliary obstruction and gastric outlet obstruction. Due to the insidious nature of the disease, up to 80-85% of individuals diagnosed with this either have metastatic or unresectable disease. As such, palliation of the disease remains central in its care. Moreover, as advances in systemic chemotherapy have led to meaningful prolongation of survival, optimizing functional status and even quality of life have become increasingly imperative.

This article traces the historical evolution of palliative interventions for pancreatic cancer, beginning with the highly morbid surgical procedure of the 19th century, such as cholecystocolonic anastomoses and the original Roux-en-Y reconstruction, progressing to contemporary surgical approaches such as the laparoscopic loop gastrojejunostomy or hepaticojejunostomy. These surgical strategies are contrasted with the rapidly growing field of advanced endoscopy, highlighting novel, minimally-invasive techniques for palliation, including endoscopic retrograde cholangiopancreatography with stenting, duodenal stenting, endoscopic ultrasound-guided gastrojejunostomy or hepaticojejunostomy.