Two consecutive female patients presented with progressive jaundice, epigastric pain and weight loss. Cross-sectional imaging with computer tomography and magnetic resonance imaging did not show any mass lesions whereas magnetic resonance cholangiopancreatography showed common bile duct strictures. Both patients were then referred for endosonographic evaluation. Endoscopic ultrasound showed occult pancreatic head masses in both cases and endoscopic ultrasound guided fine needle aspiration confirmed the diagnosis of pancreatic cancer. Both patients then successfully underwent endoscopic palliation with endoscopic ultrasound guided celiac plexus neurolysis and insertion of self expandable metallic biliary stents. This case is reported to describe the diagnostic and therapeutic impact of endoscopic ultrasound in the management of occult pancreatic head cancer. Endoscopic ultrasound is useful in the management of pancreatic cancer. It can detect occult pancreatic lesions, provide tissue diagnosis and facilitate pain palliation.