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Underwater versus conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumors ≤20mm: A systematic review and meta-analysis

  • Author Footnotes
    # These authors contributed equally to this work.
    Xiu-He Lv
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Rong Luo
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China

    Department of Endoscopy Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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  • Qing Lu
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
    Search for articles by this author
  • Kai Deng
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
    Search for articles by this author
  • Jin-Lin Yang
    Correspondence
    Corresponding author.
    Affiliations
    Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China

    Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.
Published:October 01, 2022DOI:https://doi.org/10.1016/j.dld.2022.09.001

      Abstract

      Background and Aims

      Underwater endoscopic mucosal resection (UEMR) is an emerging technique for endoscopic resection of superficial non-ampullary duodenal epithelial tumors (SNADETs). However, compared to conventional EMR, its efficacy and safety has not been widely explored.

      Methods

      We conducted a comprehensive search using the Pubmed, Embase, and Cochrane Library databases to identify studies comparing the efficacy and safety of UEMR versus EMR for SNADETs. The main outcomes examined included en bloc resection rate, R0 resection rate, recurrence rate, procedure time, and adverse events.

      Results

      A total of 5 studies comprising 635 patients were included. All the literature included duodenal lesions smaller than 20 mm. The pooled analysis showed that UEMR could achieve a higher en bloc resection rate (OR 1.78, 95%CI: 1.17 to 2.71, P = 0.007) and shorter procedure time (MD -4.08, 95%CI: -6.44 to -1.73, P = 0.0007) than EMR. However, the pooled results did not support a superiority of UEMR over EMR for R0 resection rate (OR 1.27; 95% CI: 0.90 to 1.81, P = 0.18) or recurrence rate (OR 0.49; 95% CI: 0.15 to 1.67, P = 0.26). The occurrence of adverse events, including postoperative bleeding, intraoperative perforation, and delayed perforation, was very low in included studies.

      Conclusion

      Compared to EMR, UEMR is an effective and safe technique for SNADETs ≤20 mm.

      Keywords

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