TY - JOUR
T1 - Efficacy and safety of underwater endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumors
T2 - A systematic review and meta-analysis
AU - Bhogal, Neil
AU - Mohan, Babu
AU - Chandan, Saurabh
AU - Dhaliwal, Amaninder
AU - Ponnada, Suresh
AU - Bhat, Ishfaq
AU - Singh, Shailender
AU - Adler, Douglas G.
N1 - Funding Information:
We would like to acknowledge Emily Glenn in the McGoogan Library at the University of Nebraska, School of Medicine for providing assistance with a literature review. We would also like to acknowledge Kenneth Binmoeller, MD, at California Pacific Medical Center, for pioneering the technique of UEMR.
Publisher Copyright:
© 2020 Hellenic Society of Gastroenterology.
PY - 2020
Y1 - 2020
N2 - Background Superficial non-ampullary duodenal epithelial tumors (SNADET) are increasingly found during upper endoscopy. Underwater endoscopic mucosal resection (UEMR) is an emerging technique for the endoscopic resection of SNADET. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of this technique. Methods We conducted a comprehensive search of several databases from inception to August 2019, which included Ovid Cochrane Database of Systematic Reviews, Ovid Embase, Scopus, Ovid Cochrane Central Register of Controlled trials, Ovid MEDLINE®, and In-Process and other non-indexed citations. The primary outcome assessed was the pooled clinical success rate of UEMR. Secondary outcomes included rate of en bloc resection, pooled rate of high-grade dysplasia or intramucosal carcinoma (HGIC), and pooled rate of adverse events. Meta-regression analysis was performed based on tumor size. Results A total of 8 study arms were included for analysis with UEMR performed in a total of 258 lesions. The pooled clinical success rate was 89.9% (95% confidence interval [CI] 83.4-94.1). En-bloc removal was achieved in 84.6% of treated lesions (95%CI 75.5-90.7). The pooled rate of HGIC was 24.7% (95%CI 10.3-48.3). The pooled rate of adverse events was 6.9% (95%CI 2.5-17.9). This included 10 total adverse events, with the majority being self-limited delayed bleeding. There were no duodenal perforations. Conclusions UEMR for endoscopic resection of SNADET has a high efficacy. In addition, this technique has a high rate of en bloc resection and an acceptable adverse event profile. Given these data, UEMR should be considered as a method for endoscopic resection of SNADET.
AB - Background Superficial non-ampullary duodenal epithelial tumors (SNADET) are increasingly found during upper endoscopy. Underwater endoscopic mucosal resection (UEMR) is an emerging technique for the endoscopic resection of SNADET. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of this technique. Methods We conducted a comprehensive search of several databases from inception to August 2019, which included Ovid Cochrane Database of Systematic Reviews, Ovid Embase, Scopus, Ovid Cochrane Central Register of Controlled trials, Ovid MEDLINE®, and In-Process and other non-indexed citations. The primary outcome assessed was the pooled clinical success rate of UEMR. Secondary outcomes included rate of en bloc resection, pooled rate of high-grade dysplasia or intramucosal carcinoma (HGIC), and pooled rate of adverse events. Meta-regression analysis was performed based on tumor size. Results A total of 8 study arms were included for analysis with UEMR performed in a total of 258 lesions. The pooled clinical success rate was 89.9% (95% confidence interval [CI] 83.4-94.1). En-bloc removal was achieved in 84.6% of treated lesions (95%CI 75.5-90.7). The pooled rate of HGIC was 24.7% (95%CI 10.3-48.3). The pooled rate of adverse events was 6.9% (95%CI 2.5-17.9). This included 10 total adverse events, with the majority being self-limited delayed bleeding. There were no duodenal perforations. Conclusions UEMR for endoscopic resection of SNADET has a high efficacy. In addition, this technique has a high rate of en bloc resection and an acceptable adverse event profile. Given these data, UEMR should be considered as a method for endoscopic resection of SNADET.
KW - Duodenum
KW - Non-ampullary adenoma
KW - Underwater endoscopic mucosal resection
UR - http://www.scopus.com/inward/record.url?scp=85087445960&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087445960&partnerID=8YFLogxK
U2 - 10.20524/aog.2020.0504
DO - 10.20524/aog.2020.0504
M3 - Article
C2 - 32624658
AN - SCOPUS:85087445960
SN - 1108-7471
VL - 33
SP - 379
EP - 384
JO - Annals of Gastroenterology
JF - Annals of Gastroenterology
IS - 4
ER -