1.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
Clinical Endoscopy 2026;59(1):89-95
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.

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