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Background To evaluate the safety and clinical efficacy of endoscopic biliary and pancreatic duct stent placement combined with pancreatic enucleation (En) for pancreatic head cystic adenomas.Methods A retrospective study was conducted on 11 patients treated between January 2023 and December 2025. Patients were divided into the ERCP+En group (n=5), who underwent preoperative stent placement followed by En, and the En group (n=6), who underwent En alone. Perioperative data, complications, and follow-up outcomes were analyzed and compared.Results The baseline characteristics were comparable between the two groups. The ERCP+En group showed a significantly lower incidence of clinically relevant postoperative pancreatic fistula (POPF) compared to the En group (0% vs. 2/6, 33.3%, P<0.05). The median hospital stay was also shorter in the ERCP+En group (11 days vs. 16 days, P<0.05). Operative time and blood loss were similar. During a median follow-up of 18 months, no tumor recurrence was observed. No biliopancreatic duct stricture occurred in the ERCP+En group, whereas 1 case of pancreatic duct stricture was reported in the En group.Conclusions For pancreatic head cystic adenomas, preoperative endoscopic biliopancreatic duct stent placement combined with En is a safe and effective strategy. It is associated with a reduced rate of severe pancreatic fistula and a lower risk of long-term ductal stenosis.