Endoscopic submucosal dissection (ESD) outperforms endoscopic papillectomy (EP) for ampullary tumors ≥20 mm in base size.

• ESD achieved 100% en bloc resection and 89.5% R0 rates compared to 71.7% and 30.2% for EP.
• ESD showed 0% residual disease versus 42.9% with EP during over a year of follow-up.

Consider ESD for better outcomes despite its technical demands, especially in larger tumors.

• Overall adverse event rates were similar: 36.8% for ESD and 22.6% for EP.

EUS-guided pancreaticogastrostomy followed by pancreatoscopy is effective for managing pancreatic head duct stones.

• 95% technical success rate for EUS-guided pancreaticogastrostomy in 20 patients.
• Complete stone clearance achieved in 89% of those treated with subsequent pancreatoscopy-guided lithotripsy.

This method is safe, with only mild early adverse events and a 6% recurrence rate.

• No late adverse events were reported, supporting EUS-pgs as a reliable first-line intervention.