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Background: PBD for pancreatic cancer is widely practiced despite a recent randomized study demonstrating increased morbidity in patients undergoing pancreatoduodenectomy (PD) after PBD. The role for PBD remains unclear, particularly in those patients who present with deep jaundice. The goal of this study was to analyze the clinical characteristics and outcomes of patients with resectable pancreatic cancer who underwent endoscopic PBD, with particular emphasis on patients who present with deep jaundice. Methods: A retrospective cohort study of patients who underwent PBD via ERCP prior to PD for pancreatic cancer between 3/2008-5/2010 was performed. Patient characteristics at clinical presentation as well as PBD-specific and postoperative complications were examined. The incidence of complications among patients with or without deep jaundice (total bilirubin > 14.6 mg/dL) at the time of PBD was analyzed. Two-way statistical comparisons were performed.Results: Eighty-eight patients underwent PBD for potentially resectable pancreatic cancer. Sixty-two patients (70%) went on to operative exploration after 26 patients (30%) refused surgery or were not medically fit. Complete operative resection was accomplished in 46 patients, 14 of whom (30%) had deep jaundice prior to PBD. Median age was 70 years (range, 48-87). PBD was successful in relieving jaundice in 98% of patients. PBD-specific complications, namely cholangitis, were recorded in 2 patients (6%), with no PBD-specific mortality. The majority of stents were ≥10Fr plastic (73.9%) or metallic (8.7%).The median time from PBD to operation was 4 weeks (range, 0-30). Operative complications were recorded in 56% of patients: Clavien class I (23%), II (39%), III (19%), and IV (8%). There were 3 postoperative deaths. Median length of postoperative stay was 8 days (range, 5-32). There were no statistical differences in PBD-related (7.1% vs. 12.9%, p=1.0) or operative (50% vs. 58%, p=0.74) complications for patients with or without deep jaundice, respectively. Among patients who did not undergo neoadjuvant therapy (n=39), the median time to surgery from PBD was similar for deep (18 days, range 7-43) and non-deep jaundice (27 days, range 5-175) patients (p=0.09).Conclusion: Patients with pancreatic cancer and obstructive jaundice often present with deep jaundice. PBD-related complications are uncommon at an expert endoscopic referral center, irrespective of the depth of jaundice at presentation. The benefits of PBD prior to PD in patients who present with deep jaundice are not established, and the optimal timing of PD after PBD merits further study.