To evaluate the safety and clinical effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) with biliary and pancreatic duct stenting combined with enucleation (En) for cystadenoma in pancreatic head, clinical data of patients with cystadenoma in pancreatic head treated by ERCP+En (ERCP+En group, n=11) or En (En group, n=12) at Hangzhou First People''s Hospital from January 2020 to January 2023 were retrospectively analyzed. The general information, intraoperative condition, perioperative complications, hospital stay, and follow-up outcomes were compared between the two groups. No noteworthy difference in general information was observed between the two groups (P>0.05). In the ERCP+En group, ERCP was successfully implanted into the biliary pancreatic duct stent, and hyperamylasemia occurred in 3 cases after ERCP, which improved after conservative treatment. No conversion to laparotomy or blood transfusion occurred during the En operation, and no serious complication occurred after EN operation in the two groups. There was 0 case and 3 cases of grade B/C postoperative pancreatic fistula in the ERCP+En group and the En group, respectively (P=0.001). The median hospital stay was 11 days and 15 days, respectively, with statistical significance (U=2.25,P=0.031). No noteworthy difference in median En time (145 min VS 155 min, U=0.03, P=0.952) or intraoperative blood loss (100 mL VS 120 mL, U=0.05, P=0.784) was observed between the two groups. During a median follow-up of 18 months, no recurrence happened in either group, and the ERCP+En group did not experience biliary pancreatic duct stenosis, while the En group experienced 2 pancreatic duct stenosis and 1 biliary duct stenosis. Endoscopic biliary and pancreatic duct stenting combined with En is an effective way to reduce postoperative pancreatic fistula and avoid long-term complications such as biliary and pancreatic duct stenosis for cystadenoma in pancreatic head.