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