Abstract Introduction Carcinoma head of pancreas (CAHOP) with EHBO is a common condition seen by gastroenterologist. There is scant data from Indian centres. Methods Retrospective analysis of our data was done. Referred cases with Carcinoma head of pancreas were registered at our centre. Diagnosis was based on imaging with cytological confirmation. Results From January 2006 to December 2011, total 190 patients with CAHOP with jaundice were referred to tertiary care centre. Median age of the patients was 60 (25—86 years), 45(24%) were female and 144(76%) were male. On evaluation CAHOP was confirmed and other malignancies ruled out. We found associated disease like diabetes in 47(25%) patients, gall stones in 32 (17%), and post cholecystectomy status in 19(10%) patients. Presenting symptoms were cholestatic jaundice in 182(96%) patients, median duration of 30days (7-270), pain right hypochondrium in 117 (62%) for median duration of 28 (6-270 days), pruritus 146 (76%) for median duration of 33 (range 7-270 days) and fever in 78 (41%) of patients. Other complaints were anorexia 146 (77%), weight loss in 152 (80%), lump abdomen in 5 (2.5%), history suggestive of gastric outlet obstruction was present in 17 (9%) and gastrointestinal bleed in 15 (8%) of patients. On examination icterus was present in 181(95%), hepatomegaly in 146 (77%), palpable gallbladder in 95(50%), lump abdomen in 36(19%), ascites in 19 (10%), succussion splash 5 (3%), supraclavicular lymph node in 3 (1.5%), and Spleen in 3 (1.5%) of patients. Median Serum Bilirubin was 8.5 (range 1.9—38 mg/dl), alkaline phosphatase was 678 (66—3244), raised ALT (> 2 times) in 95 (56%) (median value of 88, 10-657 IU/ml), Albumin 3.1 (1.2-4.6gm/dl). Renal failure was present in 23(12%) patients with, median serum creatinine 0.9 (range 0.5-8.8 mg/dl) Coagulopathy (INR> 1.2) in 20(10%), type 1 biliary block in 168 (90%), Type 2 block in 17(6%), type 3 & 4 block in 5 (4%) patients. Liver infiltration was noted in 9 (4%), distant metastasis in 43 (23%), and ascites in 20 (11%) patients. Lymphadenopathy was noted in 79 (41%), stage N1 in 30(16% of total, 38% of nodal mets) N2 in 49 (26%of total, 62% of nodal mets), duodenal infiltration in 55(29%) and major vessel invasion in 30 (16%) of patients. American joint committees for cancer stage 1 in 15 (9%), AJCC stage 2 in 49 (26%), AJCC stage 3 in 45 (24%) and AJCC stage 4 in 80 (42%) of patients. Only 62 (33%) of patients referred to surgeon, rest of the patients either underwent palliative biliary /duodenal stenting or declined any treatment. Conclusion CAHOP is a common cause of malignant EHBO in India. Many patients presents in advanced stage with nodal metastasis, liver metastasis and duodenal infiltration.