Feasibility of pancreatic duct stent placement before endoscopic submucosal dissection for superficial duodenal neoplasms adjacent to the papilla

Ryosuke Kobayashi; Kingo Hirasawa; Yuichiro Ozeki; Atsushi Sawada; Masafumi Nishio; Chiko Sato; Haruo Miwa; Kazuya Sugimori; Shin Maeda

doi:10.5946/ce.2025.197

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Original Article Feasibility of pancreatic duct stent placement before endoscopic submucosal dissection for superficial duodenal neoplasms adjacent to the papilla: Ryosuke Kobayashi¹, Kingo Hirasawa¹, Yuichiro Ozeki¹, Atsushi Sawada¹, Masafumi Nishio¹, Chiko Sato¹, Haruo Miwa², Kazuya Sugimori², Shin Maeda³; Clinical Endoscopy 2026;59(1):89-95.
DOI: https://doi.org/10.5946/ce.2025.197
Published online: December 31, 2025

¹Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan

²Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan

³Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Correspondence: Kingo Hirasawa Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama-shi, Kanagawa 232-0024, Japan E-mail: kingo_h@yokohama-cu.ac.jp

• Received: June 19, 2025 • Revised: September 19, 2025 • Accepted: October 2, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Graphical abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
Supplementary Material
NOTES
REFERENCES

See letter "Reducing post-endoscopic submucosal dissection pancreatitis in periampullary duodenal lesions: the role of prophylactic pancreatic duct stenting" in Volume 59 on page 70.

Abstract

Background/Aims
Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and is associated with a risk of adverse events, particularly when lesions are located near the major papilla. Pancreatic duct (PD) stent may reduce the risk of post-ESD pancreatitis; however, no standard strategy has been established. This study aimed to evaluate the effectiveness and safety of PD stent placement combined with ESD for SNADETs near the major papilla.
Methods
This was a retrospective study of duodenal ESD after prophylactic PD stent placement in patients with SNADET near the major papilla at a university hospital between March 2014 and September 2023.
Results
Four lesions were located within 5 mm of the major papilla, and seven within 5 to 10 mm. The median interval between stent placement and ESD was 2 days. The en bloc and R0 resection rates were 100% and 90.9%, respectively. No stent migration occurred during ESD, and all mucosal defects were completely closed using endoscopic clips. Delayed bleeding and post-ESD pancreatitis were observed in one and two cases, respectively.
Conclusions
PD stent placement combined with ESD is an effective treatment strategy for SNADETs near the major papilla. However, the risk of post-ESD pancreatitis remains, indicating the need for further preventive strategies.
Keywords: Duodenum; Endoscopic retrograde cholangiopancreatography; Endoscopic submucosal dissection; Pancreatic duct stent; Pancreatitis

Graphical abstract

INTRODUCTION

With the advancement of diagnostic endoscopy, endoscopic resection (ER) has become widely accepted as a less invasive treatment for superficial non-ampullary duodenal tumors (SNADETs).¹^-³ However, endoscopic submucosal dissection (ESD) for SNADETs remains technically challenging and is associated with a high risk of adverse events.³^-⁶ Even when ESD is performed successfully, the risk of delayed complications remains high.³^,⁵^,⁶ Recent studies have shown that complete closure of the mucosal defect following ESD reduces the risk of delayed adverse events.⁷ However, for tumors near the major papilla, performing ESD while maintaining a clear, wall-parallel view of both the lesion and the papilla is particularly difficult. In addition, achieving complete closure of the post-ESD mucosal defect in this region poses a technical challenge. Furthermore, edema of the papilla following ESD may lead to post-procedural pancreatitis. Placement of a pancreatic duct (PD) stent is considered a preventive measure against pancreatitis; however, no standardized approach has yet been established. This study aimed to evaluate the safety and efficacy of prophylactic PD stent placement before duodenal ESD for SNADTEs located close to the major papilla.

METHODS

Enrolled patients

Between March 2014 and September 2023, 190 consecutive patients with SNADETs underwent ESD at the Yokohama City University Medical Center. Among them, 11 patients underwent PD stent placement via endoscopic retrograde cholangiopancreatography (ERCP) before ESD owing to the proximity of the tumor to the major papilla.

Indications for PD stent placement in SNADETs

All patients underwent diagnostic endoscopy before undergoing ER. Preoperative examinations were conducted using both forward- and side-viewing endoscopes (GIF-H260Z, GIF-H290Z, GIF-XZ1200, and JF-260V; Olympus). Tumor characterization was based on size and location. PD stent placement was indicated for lesions located less than 1 cm from the major duodenal papilla. The lesion size was measured endoscopically using the longest diameter. Morphological classification followed the Paris classification system.⁸

ERCP and ESD procedures

PD stent placement was performed 1 to 3 days prior to ESD. All ERCP procedures were performed under conscious sedation using a side-viewing endoscope (TJF-260V; Olympus). An ERCP catheter (MTW ERCP catheter 0120211; MTW Endoskopie Manufaktur) was advanced into the main PD using a 0.025-inch guidewire (VisiGlide 2; Olympus). A 5-Fr plastic stent (3–7 cm in length) was then placed (Geenen, Pancreatic Stent Sets; Cook Medical). Advanix Pancreatic Stent (Boston Scientific, Marlborough, MA, USA. Harmo Ray; Hanaco Medical) was inserted into the main PD. All ERCP procedures were performed by two expert endoscopists, each with experience in >1,000 ERCP procedures. On the day after ERCP, physical examinations and blood tests, including serum amylase, were conducted to rule out ERCP-related adverse events, including post-ERCP pancreatitis (PEP). After confirming the absence of complications, ESD was performed.

ESD was performed under conscious sedation or general anesthesia. An upper gastrointestinal endoscope with a water-jet system (GIF-Q260J, GIF-290T, GIF-2TQ260M; Olympus) attached to a 4-mm-long transparent hood (D-201–11804, D-201-13404; Olympus) or a small caliber-tip transparent hood (ST hood short type) (DH-28GR, DH-15GR; Fujifilm) was used. A carbon dioxide insufflation system was used in all procedures. A 1.5-mm DualKnife (KD650Q; Olympus) or HookKnife (KD-625LR; Olympus) was used for dissection. An electrosurgical unit (ICC200, VIO300D, or VIO3; ERBE) was used for electrical cutting and coagulation. Settings for the VIO3 included “Endocut I (Effect 3, Duration 3, Interval 1)” or “Precise SECT (Effect 4.5)” for mucosal incision and submucosal dissection, and “Spray COAG (Effect 2.0)” using a Dual knife or “soft COAG (Effect 4.5)” using forceps for coagulating vessels. A 0.4% sodium hyaluronate solution was used for submucosal injections in all cases. Spurting vessels were coagulated using Coagrasper or hot biopsy forceps (FD-410LR, FD-1L-1; Olympus). After tumor resection, the ulcer bed was completely closed using endoscopic clips. (HX-610-090SC, HX-610-090L; Olympus; RO-D26195C, RO-F26195C; Micro-Tech; ZP-CH; Zeon Medical Inc.). All ESD procedures were performed by a proficient endoscopist with experience in >1,000 ESD cases (Fig. 1).

Post-ESD management

Patients fasted for 2 days following ESD in the absence of concerns or adverse events related to ESD. Computed tomography (CT) was performed on patients exhibiting fever, abdominal pain, or significant elevations in serum amylase levels. Treatment was initiated based on the nature of the identified adverse events, and oral intake was postponed until clinical and laboratory abnormalities are resolved. The PD stent was removed endoscopically after confirming the absence of complications or resolution of post-ESD complications.

Measured outcomes

To assess the safety and feasibility of PD stent placement and ESD for SNADETs located near the major papilla, the following parameters were assessed: procedure time, en bloc resection rate, R0 resection rate, resected specimen size, and closure rate of post-ESD mucosal defect. R0 resection was defined as en bloc resection with histologically negative lateral and vertical margins. Intraoperative and delayed adverse events were also evaluated. An intraoperative perforation was defined as a hole in the serosal layer caused by ESD. Delayed bleeding was defined as bleeding requiring endoscopic hemostasis after ESD completion, whereas delayed perforation was defined as a perforation confirmed by CT imaging that was not identified endoscopically during ESD. Post-ESD pancreatitis was diagnosed in the presence of abdominal pain, leukocytosis with elevated serum amylase levels, and CT findings of pancreatic edema accompanied by the dirty fat sign around the pancreas following duodenal ESD.

Statistical analysis

All statistical analyses were performed using JMP software ver. 15.0 (SAS Institute). Continuous variables were expressed as medians with ranges, and categorical variables were presented as numbers and frequencies.

Ethical considerations

This study was conducted in accordance with the 2008 revision of the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of Yokohama City University Medical Center (approval number: F240800014). All patients provided written informed consent before examination and treatment.

RESULTS

Patient and lesion characteristics

The demographic and clinical characteristics of the patients are summarized in Table 1. The median age of the patients was 67 years, and 10 were men (90.9%). None of the patients was taking antithrombotic agents. The median tumor size was 22 mm. The predominant lesion morphology was flat and elevated, observed in 90.9% of cases. The lesions were located on the oral side of the major papilla in seven cases and on the anal side of the major papilla in four cases. The distance between the major papilla and the lesion was less than 5 mm in four cases and between 5 and 10 mm in seven cases.

Clinical outcomes

Clinical outcomes are presented in Table 2. The median ERCP procedure time was 21 minutes, and no post-ERCP adverse events, including PEP, were observed. The median interval between ERCP and ESD was 2 days. The median ESD procedure time was 38 minutes. The edge of the major papilla was incised in four cases. The PD stent did not migrate during ESD, and the post-ESD mucosal defect was closed using endoscopic clips in all cases. The en bloc and R0 resection rates were 100% and 90.9%, respectively. The median specimen size was 32 mm. Histopathological findings revealed intramucosal adenocarcinoma in eight cases and tubular adenoma in three cases.

Adverse events related to ESD are summarized in Table 3. Intraoperative perforation occurred in two cases, both of which were successfully managed using endoscopic clips. No cases of delayed perforation were observed. Delayed bleeding occurred in one patient and was managed effectively with endoscopic hemostasis and blood transfusion. A retroperitoneal abscess related to intraoperative perforation developed in one case and was treated with antibiotics. Post-ESD pancreatitis occurred in two cases. Plain CT revealed pancreatic edema in both cases without PD dilation, and the PD stents remained in position. Both patients recovered with conservative management (Fig. 2). The median time to PD stent removal after ESD was post-operative day (POD) 4. The median hospital stay was 12 days (range, 9–22 days) (Supplementary Table 1).

DISCUSSION

This retrospective study demonstrates a feasible treatment strategy for ESD of SNADETs located near the major papilla. ESD was completed without stent migration in all cases. Additionally, the PD stent was visualized as a landmark for the major papilla during ESD, potentially facilitating a more precise dissection and secure mucosal defect closure.

Duodenal ESD for SNADETs is associated with a high risk of adverse events, and suturing mucosal defects following ER for SNADETs can prevent delayed adverse events. Shigeta et al.⁹ reported that complete mucosal closure can reduce the incidence of delayed bleeding. However, when SNADETs are located close to the papilla, both submucosal dissection and wound closure are technically challenging because of scope maneuverability and wall-parallel view. Furthermore, wound closure in close proximity to the papilla carries the risk of obstructing pancreatic juice outflow, leading to pancreatitis.¹⁰ Our PD stent placement method before ESD enables secure mucosal closure even for wounds close to the papilla.

Fukuhara et al.¹¹ reported that external drainage of bile and pancreatic juice using endoscopic nasobiliary and nasopancreatic duct drainage by ERCP after duodenal ESD provides effective prophylaxis against delayed adverse events without the need for suturing the treatment wound. However, this method has some drawbacks, including the need for continuous management of the ESD procedure in the endoscopic room and ERCP in the fluoroscopic room, the potential for injury to the treatment wound caused by the side-viewing scope, and the risk of drainage tube removal by patients. In contrast, our treatment strategy for PD stent placement using ERCP on the day before ESD resolved these problems. However, ERCP before ESD requires several days and may result in longer hospitalization.

Pancreatitis remains one of the most significant complications associated with resection of lesions near the major papilla. Dohi et al.⁵ reported an incidence of acute pancreatitis of 2.7% following endoscopic treatment for SNADETs; however, lesion location was not specified. Although few studies have described post-procedural pancreatitis following ER for SNADETs near the major papilla, the incidence after endoscopic papillectomy (EP) for papillary lesions has been extensively studied, ranging from 8% to 19%.¹² Several systematic reviews have examined the association between PD stent placement and post-procedural pancreatitis.¹²^-¹⁴ Chandan et al.¹² reported that PD stent placement at the time of EP did not provide significant protection against pancreatitis, whereas a meta-analysis by Spadaccini et al.¹⁴ demonstrated that same-session prophylactic pancreatic stent placement was the only factor significantly associated with reduced risk of acute pancreatitis. The European Society of Gastrointestinal Endoscopy recommends prophylactic PD stenting to reduce the risk of pancreatitis after EP.¹⁵ Regarding the underlying mechanisms of post-EP pancreatitis, Aiura et al.¹⁶ suggested that PD stents may obstruct pancreatic juice outflow and that intraoperative pancreatography may also contribute to its development. In the present study, however, PD stents were placed prior to ESD, with an interval of several days between ERCP and ESD; therefore, these factors were considered unlikely to have contributed to pancreatitis in this cohort. Despite prophylactic PD stenting, the incidence of pancreatitis following ESD was 18%.

The development of pancreatitis after ESD is believed to result from several factors including transient occlusion of the PD stent, mechanical contact with the PD stent during ESD, thermal injury to the pancreas, and blunt trauma. Previous studies have suggested that mechanical stress or direct obstruction of the PD may cause pancreatitis after endoscopic procedures.¹⁷ Moreover, laparoscopic pancreatic compression has been identified as a potential cause of pancreatic leakage.¹⁸ In colonic ESD, a recent study reported that transmural thermodynamic effects on the dissected surface may contribute to the development of post-ESD electrocoagulation syndrome.¹⁹^,²⁰ Given the thinness of the duodenal wall and the proximity of the pancreas to the duodenum, thermal damage is also a plausible cause of post-ESD pancreatitis.⁵^,²¹

No consensus has been established regarding the optimal treatment for pancreatitis following endoscopic procedures involving PD stenting. Management generally follows the approach used for acute pancreatitis.²² In cases where CT imaging reveals PD dilation, stent removal may be considered based on clinical judgment. In this study, both cases of post-ESD pancreatitis were classified as mild. However, previous reports have documented severe pancreatitis even after biopsy, highlighting the importance of careful monitoring and caution.²³

This study has some limitations that should be acknowledged. First, the retrospective design and the small number of cases from a single institution may have limited the generalizability of the findings. During the study period, all patients with SNADETs located within 10 mm of the major papilla underwent ESD following PD stent placement, and no patients without PD stenting underwent ESD; therefore, the treatment outcomes of ESD with and without PD stent placement could not be directly compared. Consequently, causal inference regarding adverse events after ESD with PD stent placement is limited. Second, the procedures were performed by a single endoscopist over an extended period, during which procedural skills likely improved, potentially influencing outcomes.

In conclusion, the placement of a PD stent before ESD allowed for secure submucosal dissection and reliable closure of the wound. However, this approach did not completely prevent post-ESD pancreatitis, and the risk remained.

Supplementary Material

Supplementary Table 1. Summary of lesion characteristics and treatment outcomes.

ce-2025-197-Supplementary-Table-1.pdf

Supplementary materials related to this article can be found online at https://doi.org/10.5946/ce.2025.197.

Conflicts of Interest

The authors have no potential conflicts of interest.

Funding

None.

Author Contributions

Conceptualization: RK, KH; Data curation: RK, KH; Formal analysis: RK, KH; Investigation: RK, KH; Methodology: RK, KH, YO, MN, CS, HM, KS; Project administration: RK, KH, YO, MN, CS, HM, KS, SM; Supervision: SM; Writing–original draft: RK; Writing–review & editing: all authors.

Fig. 1.

Endoscopic submucosal dissection after pancreatic duct stent placement for a lesion near the major papilla. (A) A 50-mm flat elevated lesion was located in the descending part of the duodenum. (B) The distance between the lesion and the major papilla was less than 5 mm. (C) The lesion was resected successfully without stent migration. (D) The lesion was resected en bloc, with a specimen measuring 70×55 mm.

Fig. 2.

A case of pancreatitis after endoscopic submucosal dissection (ESD). (A) A 15-mm flat elevated lesion was located on the oral side of the major papilla. (B) ESD was performed 1 day after pancreatic duct stent placement. (C, D) After ESD, the patient developed abdominal pain with elevated serum amylase levels. Computed tomography demonstrated pancreatic edema with the dirty fat sign without pancreatic duct dilation.

Table 1.

Clinical characteristics of the study population

Characteristic	Value
Median age (range, yr)	72 (53–81)
Sex
Male	10
Female	1
Tumor size (median range, mm)	22 (6–50)
Tumor morphology
Flat elevated type	10
Depressed type	1
Tumor location
Oral side of the papilla	7
Anal side of the papilla	4
Distance between the papilla and a lesion (mm)
<5	4
5–10	7

Table 2.

Clinical outcomes of ESD and ERCP

Outcome	Value
ERCP time (min)	21 (6–44)
Period from ERCP to ESD (day)	2 (1–3)
ESD time (min)	38 (20–180)
Partial resection of papilla	4 (36.4)
En bloc resection	11 (100.0)
R0 resection	10 (90.9)
Specimen size (mm)	32 (18–70)
Histopathology
Tubular adenocarcinoma (T1a)	8 (72.7)
Tubular adenoma	3 (27.3)

Values are presented as median (range) or number (%).

ESD, endoscopic submucosal dissection; ERCP, endoscopic retrograde cholangiopancreatography.

Table 3.

Clinical course after ESD following PD stent placement

Event	Value
Adverse event
Intraoperative perforation	2 (18.2)
Delayed bleeding	1 (9.1)
Delayed perforation	0 (0)
Retroperitoneal abscess	1 (9.1)
Pancreatitis	2 (18.2)
Stent removal from ESD (POD)	4 (1–35)

Values are presented as number (%) or median (range).

ESD, endoscopic submucosal dissection; PD, pancreatic duct; POD, post-operative day.

REFERENCES

1. Navaneethan U, Hasan MK, Lourdusamy V, et al. Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review. Endosc Int Open 2016;4:E699–E708.Article PubMed PMC
2. Wang R, Mohapatra S, Jovani M, et al. Risk factors for lymph node metastasis and survival of patients with nonampullary duodenal carcinoid tumors treated with endoscopic therapy versus surgical resection: analysis of the Surveillance, Epidemiology, and End Results program. Gastrointest Endosc 2021;93:1384–1392.Article PubMed
3. Kato M, Takeuchi Y, Hoteya S, et al. Outcomes of endoscopic resection for superficial duodenal tumors: 10 years' experience in 18 Japanese high volume centers. Endoscopy 2022;54:663–670.Article PubMed
4. Kato M, Sasaki M, Mizutani M, et al. Predictors of technical difficulty with duodenal ESD. Endosc Int Open 2019;7:E1755–E1760.Article PubMed PMC
5. Dohi O, Kato M, Takeuchi Y, et al. Clinical course and management of adverse events after endoscopic resection of superficial duodenal epithelial tumors: multicenter retrospective study. Dig Endosc 2023;35:879–888.Article PubMed PDF
6. Jeon HK, Kim GH. Endoscopic Resection for superficial non-ampullary duodenal epithelial tumors. Gut Liver 2025;19:19–30.Article PubMed PMC
7. Kato M, Ochiai Y, Fukuhara S, et al. Clinical impact of closure of the mucosal defect after duodenal endoscopic submucosal dissection. Gastrointest Endosc 2019;89:87–93.Article PubMed
8. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003;58:S3–S43.Article PubMed
9. Shigeta K, Yoshida M, Yamamoto Y, et al. Risk factors for delayed bleeding after endoscopic resection of non-ampullary duodenal epithelial tumors and the effectiveness of complete mucosal closure in high-risk patients. Surg Endosc 2025;39:1025–1035.Article PubMed PDF
10. Yahagi N, Takatori Y, Sasaki M, et al. Feasibility of endoscopic submucosal dissection including papilla (with video). Dig Endosc 2025;37:402–410.Article PubMed
11. Fukuhara S, Kato M, Iwasaki E, et al. External drainage of bile and pancreatic juice after endoscopic submucosal dissection for duodenal neoplasm: feasibility study (with video). Dig Endosc 2021;33:977–984.Article PubMed PDF
12. Chandan S, Canakis A, Deliwala S, et al. Prophylactic pancreatic duct stenting to reduce the risk of post-ampullectomy pancreatitis: a comprehensive review and meta-analysis of 1858 patients. Surg Endosc 2024;38:4798–4813.Article PubMed PDF
13. Wang Y, Qi M, Hao Y, et al. The efficacy of prophylactic pancreatic stents against complications of post-endoscopic papillectomy or endoscopic ampullectomy: a systematic review and meta-analysis. Therap Adv Gastroenterol 2019;12:1756284819855342.Article PubMed PMC PDF
14. Spadaccini M, Fugazza A, Frazzoni L, et al. Endoscopic papillectomy for neoplastic ampullary lesions: A systematic review with pooled analysis. United European Gastroenterol J 2020;8:44–51.Article PubMed PMC PDF
15. Vanbiervliet G, Strijker M, Arvanitakis M, et al. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021;53:429–448.Article PubMed
16. Aiura K, Imaeda H, Kitajima M, et al. Balloon-catheter-assisted endoscopic snare papillectomy for benign tumors of the major duodenal papilla. Gastrointest Endosc 2003;57:743–747.Article PubMed
17. Kopacova M, Tacheci I, Rejchrt S, et al. Double balloon enteroscopy and acute pancreatitis. World J Gastroenterol 2010;16:2331–2340.Article PubMed PMC
18. Ida S, Hiki N, Ishizawa T, et al. Pancreatic compression during lymph node dissection in laparoscopic gastrectomy: possible cause of pancreatic leakage. J Gastric Cancer 2018;18:134–141.Article PubMed PMC PDF
19. Cha JM, Lim KS, Lee SH, et al. Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study. Endoscopy 2013;45:202–207.Article PubMed
20. Ochi M, Yamamoto A, Suematsu S, et al. High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome: a multicenter prospective study. World J Gastrointest Endosc 2024;16:668–677.Article PubMed PMC
21. Lee JH, Kedia P, Stavropoulos SN, et al. AGA clinical practice update on endoscopic management of perforations in gastrointestinal tract: expert review. Clin Gastroenterol Hepatol 2021;19:2252–2261.Article PubMed
22. Tenner S, Vege SS, Sheth SG, et al. American College of Gastroenterology guidelines: management of acute pancreatitis. Am J Gastroenterol 2024;119:419–437.Article PubMed
23. Ishibash Y, Iwai T, Miyata E, et al. Two cases of severe acute pancreatitis following duodenal papillary biopsy. Prog Dig Endosc 2018;92:108–109.Article

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Reducing post-endoscopic submucosal dissection pancreatitis in periampullary duodenal lesions: the role of prophylactic pancreatic duct stenting
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Feasibility of pancreatic duct stent placement before endoscopic submucosal dissection for superficial duodenal neoplasms adjacent to the papilla

Clin Endosc. 2026;59(1):89-95. Published online December 31, 2025

DOI: https://doi.org/10.5946/ce.2025.197

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Feasibility of pancreatic duct stent placement before endoscopic submucosal dissection for superficial duodenal neoplasms adjacent to the papilla

Fig. 1. Endoscopic submucosal dissection after pancreatic duct stent placement for a lesion near the major papilla. (A) A 50-mm flat elevated lesion was located in the descending part of the duodenum. (B) The distance between the lesion and the major papilla was less than 5 mm. (C) The lesion was resected successfully without stent migration. (D) The lesion was resected en bloc, with a specimen measuring 70×55 mm.

Fig. 2. A case of pancreatitis after endoscopic submucosal dissection (ESD). (A) A 15-mm flat elevated lesion was located on the oral side of the major papilla. (B) ESD was performed 1 day after pancreatic duct stent placement. (C, D) After ESD, the patient developed abdominal pain with elevated serum amylase levels. Computed tomography demonstrated pancreatic edema with the dirty fat sign without pancreatic duct dilation.

Graphical abstract

Fig. 1.

Fig. 2.

Graphical abstract

Feasibility of pancreatic duct stent placement before endoscopic submucosal dissection for superficial duodenal neoplasms adjacent to the papilla

Characteristic	Value
Median age (range, yr)	72 (53–81)
Sex
Male	10
Female	1
Tumor size (median range, mm)	22 (6–50)
Tumor morphology
Flat elevated type	10
Depressed type	1
Tumor location
Oral side of the papilla	7
Anal side of the papilla	4
Distance between the papilla and a lesion (mm)
<5	4
5–10	7

Outcome	Value
ERCP time (min)	21 (6–44)
Period from ERCP to ESD (day)	2 (1–3)
ESD time (min)	38 (20–180)
Partial resection of papilla	4 (36.4)
En bloc resection	11 (100.0)
R0 resection	10 (90.9)
Specimen size (mm)	32 (18–70)
Histopathology
Tubular adenocarcinoma (T1a)	8 (72.7)
Tubular adenoma	3 (27.3)

Event	Value
Adverse event
Intraoperative perforation	2 (18.2)
Delayed bleeding	1 (9.1)
Delayed perforation	0 (0)
Retroperitoneal abscess	1 (9.1)
Pancreatitis	2 (18.2)
Stent removal from ESD (POD)	4 (1–35)

Table 1. Clinical characteristics of the study population

Table 2. Clinical outcomes of ESD and ERCP

Values are presented as median (range) or number (%).

ESD, endoscopic submucosal dissection; ERCP, endoscopic retrograde cholangiopancreatography.

Table 3. Clinical course after ESD following PD stent placement

Values are presented as number (%) or median (range).

ESD, endoscopic submucosal dissection; PD, pancreatic duct; POD, post-operative day.