Endoscopic submucosal dissection (ESD) for periampullary duodenal lesions is known to be technically challenging. Because of its close proximity to the papilla, this procedure carries a risk of post-procedural pancreatitis. Such complications may arise from mechanical trauma, thermal injury during dissection, or inadvertent obstruction of pancreatic duct outflow during mucosal defect closure.

In an editorial published by Prof. Ari Fahrial Syam in Clinical Endoscopy (2026), entitled Reducing post-endoscopic submucosal dissection pancreatitis in periampullary duodenal lesions: the role of prophylactic pancreatic duct stenting, the potential use of prophylactic pancreatic duct stenting before or during ESD is discussed. The goal is straightforward yet important: to maintain pancreatic juice flow and prevent ductal obstruction that could trigger pancreatitis.

This approach is considered physiologically reasonable and may enhance procedural safety, particularly in lesions located very close to the papilla. However, the editorial emphasizes that its application should be carefully tailored, taking into account patient characteristics, lesion complexity, and operator expertise. Current evidence remains limited and needs to be strengthened through larger prospective studies and randomized clinical trials.

Overall, this editorial serves as a reminder that innovation in endoscopic techniques must always be balanced with patient safety and thoughtful selection of preventive strategies.

Read the full article at:
https://pubmed.ncbi.nlm.nih.gov/41612830/

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