Endoscopic submucosal dissection (ESD) has emerged as a safe and effective treatment option for heterotopic pancreas—particularly when lesions are located in the stomach or duodenum and exhibit symptoms such as bleeding, obstruction, or chronic abdominal pain. Heterotopic pancreas refers to ectopic pancreatic tissue that lacks anatomical or vascular continuity with the main pancreatic gland; it is most commonly found in the gastric antrum or proximal duodenum.

Multiple clinical studies have demonstrated high en bloc resection rates (>95%) and low local recurrence rates (<2%) following ESD for symptomatic or suspicious heterotopic pancreas. The procedure offers significant advantages over surgical resection—including shorter hospital stays, faster recovery, preservation of organ function, and reduced perioperative morbidity. However, technical success depends heavily on lesion size, location, fibrosis degree, and operator expertise.

Complication rates—including intraoperative bleeding, perforation, and post-procedural delayed bleeding—are generally low (<5% combined) when performed by experienced endoscopists in high-volume centers. Careful pre-procedural assessment using high-definition endoscopy, chromoendoscopy, and endoscopic ultrasound (EUS) is essential to confirm diagnosis, exclude malignancy, and evaluate submucosal infiltration depth.

While ESD is not indicated for asymptomatic, incidentally discovered heterotopic pancreas, it is considered a reliable first-line intervention for selected patients with confirmed symptomatic lesions. Long-term follow-up remains recommended to monitor for rare complications or recurrence, though current evidence supports its durability and safety profile in appropriately selected cases.