First, jaundice was a consequence of direct compression by tumor and/or biliary obstruction by viscid mucin accumulation.[4] In the former case, patients tend to respond well to ENBD and percutaneous transhepatic cholangial drainage (PTCD).[5] However, in the latter situation, PTCD is likely to be ineffective due to rapid occlusion by thick mucin. This evidence concerns the gene MUC5AC and neoplasm.