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Underwater Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors: A Systematic Review and Meta-Analysis

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Abstract

Background/Aims

Duodenal underwater endoscopic mucosal resection (UEMR) has been suggested as a feasible treatment option for superficial non-ampullary duodenal epithelial tumors (SNADETs). However, its efficacy and safety have not been fully established yet. Thus, the objective of this systematic review and meta-analysis was to determine the efficacy and safety of UEMR as compared with conventional endoscopic mucosal resection (CEMR) in the treatment of SNADETs.

Methods

We conducted a comprehensive literature search in PubMed, EMBASE, the Cochrane Library. Studies comparing CEMR and UEMR for the resection of SNADET were included. Outcomes included en-bloc and complete resection rates, adverse events, and procedure time.

Results

A total of six studies with 2454 lesions were included in the quantitative synthesis. En-bloc and complete resection rates were not significantly different between UEMR and CEMR (OR for en-bloc resection: 0.997 [95% CI 0.439–2.266]; OR for complete resection: 0.960 [95% CI 0.628–1.468]). There was no significant risk difference for perforation (risk difference: − 0.002; 95% CI − 0.009 to 0.005) or delayed bleeding (risk difference: − 0.001; 95% CI − 0.014 to 0.011). Procedure time was significantly shorter in the UEMR (standardized mean difference: − 1.294; 95% CI − 2.461 to − 0.127). The risk of recurrence was not significantly different between UEMR and CEMR (risk difference: 0.001; 95% CI − 0.041 to 0.044).

Conclusion

Although our results did not show any superiority of UEMR over CEMR in the treatment of SNADETs, UEMR showed equivalent efficacy and safety as compared with CEMR and was associated with a shorter procedure time.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, 18450, Korea

    Jae Gon Lee, Sang Pyo Lee, Hyun Joo Jang & Sea Hyub Kae

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  1. Jae Gon Lee
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  2. Sang Pyo Lee
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Correspondence to Sang Pyo Lee.

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Supplementary Information

Below is the link to the electronic supplementary material.

10620_2022_7715_MOESM1_ESM.tif

Supplementary file1 Figure S1. Summary of results from Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). (TIF 46173 kb)

Appendix 1: Detailed Literature Search Strategy

Appendix 1: Detailed Literature Search Strategy

PubMed

((underwater endoscopic resection) OR (underwater endoscopic mucosal resection) OR (underwater EMR) OR “UEMR” OR “U-EMR” OR “UW-EMR”) AND ((duoden*) OR (non-ampullary) OR (nonampullary) OR (small bowel)) AND ((polyp*) OR (neoplas*) OR (tumor*) OR (adenoma*) OR (carcinoma*) OR (lesion*)) AND (English[Language]).

Embase

  1. 1.

    (underwater endoscopic resection or underwater endoscopic mucosal resection or underwater EMR or “UEMR” or “U-EMR” or “UW-EMR”).af.

  2. 2.

    (duoden* or non-ampullary or nonampullary or small bowel).af.

  3. 3.

    (polyp* or neoplas* or tumor* or adenoma* or carcinoma* or lesion*).af.

  4. 4.

    1 and 2 and 3

Cochrane Library

#1 (underwater endoscopic resection or underwater endoscopic mucosal resection or underwater EMR or “UEMR” or “U-EMR” or “UW-EMR”).

#2 (duoden* or non-ampullary or nonampullary or small bowel).

#3 (polyp* or neoplas* or tumor* or adenoma* or carcinoma* or lesion*).

#4 #1 and #2 and #3.

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Lee, J.G., Lee, S.P., Jang, H.J. et al. Underwater Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors: A Systematic Review and Meta-Analysis. Dig Dis Sci 68, 1482–1491 (2023). https://doi.org/10.1007/s10620-022-07715-1

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