Endoscopy 2025; 57(S 02): S29-S30
DOI: 10.1055/s-0045-1805147
Abstracts | ESGE Days 2025
Oral presentation
Endoscopic Resections in the Duodenum 03/04/2025, 10:30 – 11:30 Room 124+125

Safety and Efficacy of Duodenal Endoscopic Submucosal Dissection for non-ampullary lesion: a systematic review and meta-analysis

Authors

  • A Rimondi

    1   Royal Free Hospital, London, United Kingdom

  • E Dell'Unto

    2   Sapienza University of Rome, Rome, Italy

  • R Morais

    3   Unidade Local de Saúde de São João, Department of Gastrenterology, Porto, Portugal

  • G Esposito

    2   Sapienza University of Rome, Rome, Italy

  • J Santos-Antunes

    3   Unidade Local de Saúde de São João, Department of Gastrenterology, Porto, Portugal

  • G E Tontini

    4   Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy, Milan, Italy
    5   IRCCS Foundation Ca' Granda Maggiore Policlinico Hospital, Milan, Italy

  • R Haidry

    6   Cleveland Clinic London Hospital, London, United Kingdom

  • J Jacques

    7   CHU Dupuytren 1, Limoges, France

  • E J Despott

    1   Royal Free Hospital, London, United Kingdom

  • A Murino

    1   Royal Free Hospital, London, United Kingdom
    6   Cleveland Clinic London Hospital, London, United Kingdom
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Aims The indications for endoscopic submucosal dissection (ESD) have been constantly increasing since its introduction [1]. The duodenum represents a difficult endoscopic scenario due to its thin wall and the potential consequences of endoscopic adverse events [2] [3]. We performed a systematic review and meta-analysis to assess the current state of the art.

Methods We performed a systematic review of EMBASE and MEDLINE databases up to 18th October 2024 according to PRISMA guidelines and the Joanna Briggs Institute methodologies. We included all studies on human endoscopy. Literature was searched to answer the following question: “Is it effective and safe to conduct endoscopic submucosal dissection in non-ampullary duodenal lesions?”. A pooled prognosis meta-analysis was performed. Risk of bias was evaluated according to GRADE. Separate sub-analysis on SNADET and western studies were performed. PROSPERO database (CRD42024517598).

Results After screening 514 papers, a total of 54 studies accounting for 3672 patients were included in a systematic review and meta-analysis. Mean age stood at 62.0 years (SD±0.8), the mean size of the resected NADL was 19.5mm (SD±1.2) and the mean procedure time was 59.8 min (SD±4.1). The efficacy and safety performance of ESD for non-ampullary duodenal lesions (NADL) were as follow: en-bloc 98.1% (95%CI 96.2-99.1), R0 86.3% (95%CI 82.0- 89.7%), intraprocedural perforation 8.5% (95%CI 6.4-11.2%), intraprocedural bleeding 0.01% (95%CI 0.001-0.1%), delayed perforation 2.0% (95%CI 1.3-3.1%), delayed bleeding 3.8% (95%CI 2.8-5.2%), need for surgery 1.2% (95%CI 0.6-2.5%). An overall low quantity of recurrence and mortality frequency was observed. Quality of evidence ranged from very low to moderate, most of the evidence came from Asian centres (48/54, 88.8%) and from retrospective single monocentric studies (45/84, 83.3%).

Conclusions ESD for NADL can be considered an alternative to standard techniques or surgery when en-bloc and R0 resection is requested. High experience and proficiency in this technique is required to replicate the outcomes found by this metanalysis.



Publication History

Article published online:
27 March 2025

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