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Pancreaticobiliary cancer remains a challenging cancer to treat, with a small group of patients having resectable disease and few long-term survivors. Stenting remains the treatment of choice for biliary obstruction, but optimal stenting is difficult. Resection and chemoradiotherapy are indicated for localized pancreatic cancer, and gemcitabine-based chemotherapy may be considered the standard of care for advanced/metastatic pancreatic disease. In the search for better therapeutic alternatives, the role of photodynamic therapy (PDT) for both pancreatic and biliary tract cancers has been evaluated. Although conflicting and often poor-quality data have emerged on the use of PDT for unresectable bile duct cancers and encouraging early-stage studies with PDT are under way for unresectable, locally advanced pancreatic cancer, definitive answers as to its efficacy can only be found in randomized controlled trials.