Clinical Outcomes of Underwater Endoscopic Submucosal Dissection for Duodenal Tumors: A Systematic Review and Meta-Analysis.

Authors

Kumiko Kirita, Teppei Akimoto, Yasunori Sato, Motoki Sasaki, Maya Ishizawa, Mai Owada, Ai Katsumi, Yuki Kubo, Misaki Sugawara, Rei Mizobe, Shoma Murata, Yuri Imura, Hinako Sakurai, Anna Tojo, Kurato Miyazaki, Teppei Masunaga, Mari Mizutani, Yusaku Takatori, Shintaro Kawasaki, Noriko Matsuura, Atsushi Nakayama, Tomohisa Sujino, Kaoru Takabayashi, Naohisa Yahagi, Motohiko Kato

Published in

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. Volume 38. Issue 8. Pages e70247.

Abstract

Underwater endoscopic submucosal dissection (U-ESD) has recently been introduced as a technique that may improve visualization and submucosal layer expansion. However, the clinical outcomes of U-ESD for duodenal tumors have not been systematically evaluated. This study aimed to assess the efficacy and safety of U-ESD for duodenal tumors through a systematic review and meta-analysis.
A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library from database inception to December 12, 2025. Studies evaluating U-ESD for duodenal tumors were included. Primary outcomes included en bloc resection, R0 resection, procedure time, adverse events, and complete mucosal defect closure. Pooled estimates were calculated using a random-effects model.
Four retrospective studies comprising 298 lesions treated with U-ESD were included. The pooled procedure time was 59 min (95% CI, 48-70 min; I² = 72%). The pooled en bloc resection rate was 99% (95% CI, 97%-100%; I² = 0%), and the pooled R0 resection rate was 89% (95% CI, 81%-93%; I² = 54%). The pooled intraoperative perforation rate was 5% (95% CI, 1%-23%; I² = 88%). The pooled delayed perforation and delayed bleeding rates were 1% (95% CI, 0%-3%; I² = 0%) and 2% (95% CI, 1%-5%; I² = 0%), respectively.
Current evidence suggests that U-ESD is a feasible treatment option for duodenal tumors and is associated with favorable clinical outcomes. However, the available evidence remains limited, and potential biases and concerns regarding generalizability warrant cautious interpretation of these findings.

PMID:
42519837
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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