Pancreatic adenocarcinoma accounts for 80% of pancreatic tumours. The majority are unresectable at diagnosis and only 10% of patients survive to 1 year. Therefore, selection of appropriate palliative procedures for jaundice, gastric outlet obstruction or pain is a vitally important aspect of the management of these patients. Overall survival is equivalent following surgical or non-surgical palliation of biliary obstruction. Operative biliary bypass is a more major intervention but is associated with longer relief of symptoms and fewer readmissions compared to non-operative procedures. Prognostic factors such as histopathology, presence of metastatic disease and C reactive protein levels may allow better prediction of survival, therefore aiding selection of the most appropriate palliative techniques.